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US Ecology Nevada(Beatty) 800-239.3943 <br /> LE c�c oio y US Ecology Idaho(Grand View) 800.274-1516 PROFILE# <br /> US Ecology Texas(Robstown) 800-242-3209 <br /> WASTE/MATERIAL PROFILE FORM U5 Ecology Michigan(Detroit) 800-396.3265 <br /> A. GENERATOR INFORMATION <br /> 1. Generator: Universal Service Recycling Inc ❑Billing information is same 0 P.O.required for payment <br /> 2. FaclHty Address: 12.BIUing Company: McDougall Environment <br /> 3200 S EI Dorado St _. <br /> Stockton,CA 95206 13.Billing Address: PO Box 450 <br /> 3. Mailing Address: 3200$EI Dorado St 14,City/State/Zip: Georgetown,CA 95634 <br /> _ .__............... <br /> 4. City/State/Zip: Stockton,CA 95206 15.Billing Contact: Sean McDougall <br /> 5, Technical Contact: Steven Stater 16.Phone: 530333-4684 j 17.Fax: <br /> 6. Phone: 209-751.9946 ' 7. Fax: 18.Emaii: sean@mcanvironmantcom <br /> 8, Generator Status: CESQG SQG ®LQG <br /> 9. EPA ID#: CAL000355717 10.State ID#: <br /> 11. NAICS CODES: ! 423930 <br /> B. SHIPPING INFORMATION <br /> 1, U5 DOT Shipping name: Waste Toxic Solids,Organic,N.O.S.(mothomyi) <br /> 2. Hazard Class: 6.1 i 3, UN/NA th UN2811 4, Packaging Group: III S. RQ: 100 lbs <br /> 6. Container Type: rj Bulk Totes Pallet Boxes Drums ®Other,Describe: <br /> 7. Frequency: Year Quarterly Monthly 1 time ®Other,Describe: <br /> 8. Shipment: Size: 5-001 Quantity: 1 9. Waste import: El Yes ONo <br /> (tf yes,campkte Waste lm Suppternemj <br /> C. GENERAL MATERIAL&REGULATORY INFORMATION <br /> 1. Common name: Ry bait <br /> 2. Process generating: <br /> Unused,aged or off-specification product <br /> 3. Describe physirai appearance: <br /> 1-gallon can of fly bait(solid pellets)placed into 5-gailan pail <br /> 4, Odor: ONone Slight ®Strong S. Physical State: ®Liquid ®Sludge/Slurry MSofid <br /> 6, Describe Color: beige 7. Liquid phases: ESIngle Double layer Multi-layer <br /> 8, Knowledge Is from: _❑Lab analysisN MSDS ✓ process/generator knowledge <br /> 9, Waste/Material Type(US Ecology Texas customers only): ® N/A industrial Non-Industrial <br /> 10. Restricted under EPA Land Disposal Restrictions(9268)7 0 Yes ®No <br /> 11. If LDR"Yes": Owastewater 0 Non-wastewater Debris(§268.2) 1 12. Alt.Standards for soli? Yes 0140 <br /> i3. Is the material RCRA hazardous waste containing benzene and originating at a Petroleum Refinery(SIC 2911),Chemical <br /> Manufacturing Plant(SIC 2600 thru 2899)or Coke by-Product Recovery Plant(SIC 3312)7 of yes,compkts @eruene ®Yes ONo <br /> Wat_eatedialOperations SupphrmentFarmond 11termal Su kmentForm: <br /> 14. VO Conc.(§264.1083): EJ<500 ppmw ®2500ppmwT117, <br /> Has it been treated after point of generation? Yes No <br /> 16, CERCLA Regulated ISuperfund)waste: Yes . NaButadiene waste regulated by§63 Subpart XX: Yes W No <br /> 18. waste contains UHC constituent(s)(§268.48),above a treatment standsrd,other than those for whkh the waste exhibits a Yes ONO <br /> characteristic. (r/Ees,ttstallUfiCslaSectkn0): <br /> 19. waste exempt from definition of"solid waste"or"hazardous waste" (If yes,list reference 40CFR j: Yes ONo <br /> 20. State waste Codes: <br /> 21,�RCRA Waste cOd@S: � POW <br /> 22. Source Code: G11 Discard 23. Form Code: W401 Pestic 24. Management Code: H (USE only) <br /> Revision date:06/24/16 Page Z <br />