COMPLIANCE INFO_2020 (2) - Laserfiche WebLink

Home Browse Search

0 wi FZ Profile TM WASTE MANAGEMENT Requested Facility: Lockwood Regional Landfill (Refuse, Inc.) ❑Unsure Profile Number: 117103NV ❑Multiple Generator Locations(Attach Locations) Ild Request Certificate of Disposal 0 Renewal?Original Profile Number: 117103NV A.GENERATOR INFORMATION(MATERIAL ORIGIN) B.BILLING INFORMATION I_l SAME AS GENERATOR 1. Generator Name: USR Nevada 1. Billing Name:Universal Service Recycling. Inc. 2.Site Address: 8455 Sheep Dr 2. Billing Address:3200 South EI Dorado (City,State,ZIP) Carson City NV 89701 (City,State,ZIP) Stockton CA 95206 3. County: 3.Contact Name:Richard Balch 4. Contact Name:William Menrionca/Tom Hightower 4. Email Jrbal h usrscran com 5. Email: wmendonca&usrscrap_com 5. Phone: 6. Fax: (209)944-5552 6. Phone:(20A)c)44-9555 7. Fax: (2227?9)944-5552 7.WM Hauled? ❑Yes 0 No 8. Generator EPA ID: 19 N/A 8. P.O.Number: 9. State ID: El N/A 9. Payment Method: 0 Credit Account ❑Cash ❑Credit Card C.MATERIAL INFORMATION D,REGULATORY INFORMATION 1. Common Name:Metal shredder Residue 1. EPA Hazardous Waste? ❑Yes* 0 No Describe Process Generating Material: ❑See Attached Code: Material delivered to site in and processed to recover metallic's and 2. State Hazardous Waste? ❑Yes 0 No plastic using eddy current separator,magnets and infrared scanner. Code: Materials shredded are aluminum,tin and appliances.No auto bodies 3. Is this material non-hazardous due to Treatment, have been or will be shredded Delisting,or an Exclusion? ❑Yes ONO 4. Contains Underlying Hazardous Constituents? LJ Yes* 0 No 2. Material Composition and Contaminants: LJ See Attached 5. From an industry regulated under Benzene NESHAP? LJ Yes* 0 No 1.Rubber 2 ', 6. Facility remediation subject to 40 CFR 63 GGGGG? L1 Yes* 0 No 2.Dirt 60%% 7 CERCLA or State-mandated clean-up? L3Yes* 0 No 3.Glass 8 8. NRC or State-regulated radioactive or NORM waste? ❑Yes* 0 No 4.Foam Rubber 30% *If Yes,see Addendum(page 2)for additional questions and space. Total comp.must be equal to or greater than 100% >-100% 3. State Waste Codes: 0 N/A '' 9•Contains PCBs? 4 I Yes,answer a,b and c. Id Yes Ll No 4. Color:Brown and White a. Regulated by 40 CFR 761? LJ Yes Ell No b. Remediation under 40 CFR 761.61 (a)? ❑Yes El No 5. Physical State at 70°F: El Solid ❑Liquid ❑Other: c. Were PCB imported into the US? ❑Yes 0 No 6. Free Liquid Range Percentage: to 0 N/A 10.Regulated and/or Untreated LJ Yes 0 No 7.pH: to 0 N/A Medical/Infectious Waste? 8. Strong Odor: ❑Yes E1 No Describe: 11.Contains Asbestos? ❑Yes 0 No 9. Flash Point: ❑<140°F ❑ 140°-199°F 0_>200° ❑N/A 4 If Yes: ❑Non-Friable ❑Non-Friable-Regulated ❑Friable E.ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION F.SHIPPING AND DOT INFORMATION 1.Analytical attached 0 Yes 1. ❑One-Time Event 0 Repeat Event/Ongoing Business Please identify applicable samples and/or lab reports: 2. Estimated Quantity/Unit of Measure: 7200 PCB report and VOC report 0 Tons ❑Yards ❑Drums ❑Gallons ❑Other: 3. Container Type and Size:40 Yard Roll-off or Endump i 4. USDOT Proper Shipping Name: 0 N/A 2.Other information attached(such as MSDS)? ❑Yes !I I G.GENERATOR CERTIFICATION(PLEASE READ AND CERTIFY BY SIGNATURE) By signing this EZ Profile`form,I hereby certify that all information submitted in this and all attached documents contain true and accurate descriptions of this material,and that all relevant information necessary for proper material characterization and to identify known and suspected hazards has been provided. Any analytical data attached was derived from a sample that is representative as defined in 40 CFR 261 -Appendix 1 or by using an equivalent method. All changes occurring in the character of the material(i.e.,changes in the process or new analytical)will be identified by the Generator and be disclosed to Waste Management prior to providing the material to Waste Management. If I am an agent signing on behalf of the Generator,I have confirmed with the Certification Signature Generator that information contained in this Profile is accurate and complete. Name(Print): Alexis Williams Date: 03/27/2019 s Title: CFO Company: Universal Service Recycling, Inc. Revised June 30,2015 THINK GREENO QUESTIONS?CALL 800 963 4776 FOR ASSISTANCE ©2015 Waste Management