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Special Waste Profile Recertification SERVICES <br /> Disposal Facility: 4041 ECDC Environmental Landfill UT El <br /> waste Profile#: 4041168405 <br /> Sales Rep#: <br /> I.Generator Information <br /> Generator Name 'Universal Service Recycling, Inc. <br /> Generator site Address: 3200 S EI Dorado St <br /> City: `Stockton County: 'San Joaquin State: California Zip: <br /> 95206 <br /> State ID/Reg No: CAL000355717 State Approval/Waste Code 613 SES SEC III NAICS: A2193 <br /> Generator Mailing Address ❑ (if different) <br /> City: County: State: --Select State— Lip. <br /> Generator Contact Name: WILLIAM MENDONCA Email. Wmendonca@usrscrap.Com <br /> Phone Number 209-944-9555 Ext Fax Number: i209_944_5552 <br /> II.Waste Stream Information <br /> Name of Waste: SHREDDER RESIDUE CSC(NON-RCRA WATE) <br /> Check Section 9 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 and/or SDS <br /> must be provided as appropriate. <br /> 2. E7 There have been no changes that would alter the physical characteristics of the special waste stream. <br /> Updated analytical may he required. <br /> III.Representative Sample Certification <br /> Ca No Sample Taken <br /> ❑ YP Sample Taken Type of Sample , Sample <br /> P p Graamp_ <br /> Is the representabve sample collected to repp are this r and lab ratory analysis,collected in accordance with U.S.EPA 40 CFR <br /> 261.20(c)guidelines or equivalent? yes E3N 11,1-7-1 z <br /> Sample `, rB._ Sample ID 1-Q-20-B, SEE LABS ATTACHED <br /> Date: t iNumbers: <br /> Ir <br /> Universal Service Recycling Inc. SHREDDER RESIDUE CSC(NON-RCRA WATE) <br /> i <br />