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'LIC' Republic Services <br /> 18500 N.Allied Way,Phoenix,AZ 85054 <br /> SPECIAL WASTE DEPARTMENT DECISION <br /> Waste Profile# Expiration Date <br /> 4041168405 7/31/2020 v_ <br /> I.Decision Request: —� ❑Initial 0 Recertification ❑Change <br /> Disposal Facility:4041-ECDC Environmental OF _ <br /> Generator Name:UNIVERSAL SERVICE RECYCLING INC. <br /> Generator Site Address:3200 S EL DORADO ST _ <br /> City:STOCKTON -�County: State:CA ---Jzip: -� <br /> Name of Waste:SHREDDER RESIDUE CSC H010(NON-RCRA WASTE) <br /> Estimated Annual Volume:3200 Tons <br /> II.Special Waste Department Decision: R1 Approved ❑Rejected <br /> Management Method(s): ❑Landfill ❑Solidification ❑Bioremediation Deep Well El Transfer Facility <br /> Problematic Special Waste according to Republic? ❑Yes No <br /> If yes,which one? <br /> Approved by Special Waste Review Committee? ❑Yes ❑No ❑Not Applicable <br /> Precautions,Conditions or Limitations on Approval <br /> The generator must supply Total PCBs(reported as mg/kg dry),TCLP 8 RCRA metals testing semi-annual basis. The next sample <br /> must be taken between 1/2/2020 and 6/3012020. A completed Recertification form must accompany the semi-annual analytical <br /> and be submitted to the Special Waste Group prior to 7/31/2020. <br /> Special Waste Analyst Signature: Name(Printed): Suzanne Glass <br /> Date:2111/2020 <br /> III.Facility Decision: ❑Ar ved ❑Rejected <br /> Precautions,Conditions or Limitations on Approval <br /> By signing below,the General Manager or Designee agrees that a fully executed Special Waste Service Agreement is on file for this profile and that the <br /> special waste file is complete. <br /> General Manager or Designee: Name(Printed): <br /> Date:2/1112020 <br /> i <br /> i <br />