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PU LI ` <br /> Special Waste Profile - Recertification SERVICES <br /> Disposal Facility: x4041 ECDC Environmental Landfill UT �f Waste Profile# E4.041 16$405 <br /> Sales Rep#: <br /> 1.Generator Information <br /> — <br /> Generator Universal versal Service Recycling, Inc. <br /> Generator Site Address. `3200 S EI Dorado St <br /> CityStockton County =San Joaquin state Clifrrr.i£ Ell zip 195206 i <br /> o n -� <br /> State ID/Reg No: iCAL000355717 State Approval/Waste Code 613 SES SEC Ill NAILS: 42193 <br /> Generator Mailing Address ❑ (if different) <br /> Cry, i County: Stat€ --Select State-- Zip <br /> Generator Contact Name: William Mendonea i E m ai.I wmendonca@usrscrap.com <br /> 209-944-95 -- -_ [26P-944-5552 <br /> Phone Number 5jj Ext: Fax Number: <br /> II.Waste Stream Information <br /> Name of Waste ,SHREDDER RESIDUE CSC(NON RCRA WASTE} <br /> Check Section 1 or 2 below <br /> 1. ❑There has been a change in the characteristics of the waste stream due to the following: <br /> a. Change of a raw material used in the waste generating process. <br /> b. Change in the waste generating process itself. <br /> c. Change in a physical characteristic of the waste. <br /> d. New information has been documented concerning the human health effects of exposure to the waste, <br /> if any of these changes have occurred,a new profile sheet must be completed,and new analysis andlor SOS <br /> must be provided as appropriate. <br /> 2. LD There have been no changes that would alter the physical characteristics of the special waste stream. <br /> Updated analytical may be required. <br /> III.Representative Sample Certification <br /> ®No Sample Taken <br /> Sample Taken Type of Sample Grab Sample _ <br /> is the representative sample collected to prepare this profile andlaboratory analysis,collected in accordance with U.S.EPA 40 CFR <br /> 2b1.20(c)guidelines or'equivalent? [dyes ENO <br /> ------------- <br /> Sample ;1/3/2020 Sample ID 1-Q-20-B , SEE LABS ATTACHED <br /> Date: Numbers <br /> E <br /> pug,, Universal Service Recycling,Inc. SHREDDER RESIDUE CSC(NON•RCRA WASTE) <br />