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US Ecology Nevada(Beatty) 800.239-3943 <br /> U5 ecology US Ecology Idaho(Grand View) 800-274-1516 PROFILE#070128300-30534 <br /> US Ecology Texas(Robstown) 800-242-3209 <br /> WASTE/MATERIAL PROFILE FORM US Ecology Michigan(Detroit) 800-396.3265 <br /> A. GENERATOR INFORMATION <br /> 1. Generator: Superstore Industries/Grocery Division ❑Billing information is same ❑P,O.required for payment <br /> 2. Facility Address: 12.Billing Company:FREMOUW ENVIRONMENTAL SERVICES <br /> 16888 McKinley Ave. <br /> 13.Billing Address: 6940 TREMONT RD. <br /> 3. Mailing Address: 14.City/State/Zip: DIXON,CA 95620 <br /> 4. City/State/Zip: Lathrop,CA 95330 15.Billing Contact: DINAIPATRICKIANNElJARED <br /> S. Technical Contact: Jamie Lima 16.Phone:(707)448-3700 17.Fax: (707)448-3499 <br /> 6. Picone: 209-814-4432 7. Fax: 18.Email., AP®HAZWASTEREMOVAL.COM <br /> 8. Generator Status: ❑VSQG/CESQG ❑SQG ❑LQG <br /> 9. EPA ID#: CAL921206046 10.State ID M <br /> 11. NAiCS CODES: 9999 <br /> B. SHIPPING INFORMATION <br /> 1. US DOT Shipping name: Non-RCRA Hazardous Waste Solid(Household Cleaners) <br /> 2. Hazard Class: NIA 3. UN/NA#: NIA 4. Packaging Group: NIA S. RQ* NIA <br /> 6. Container Type: ❑Bulk ❑Totes ❑Pallet ❑Boxes ❑Drums ❑Other,Describe: <br /> 7. Frequency: ❑Year ❑Quarterly ❑Monthly ❑1 time ❑Other,Describe: <br /> 8. Shipment: Size: 559 Quantity: 1'2 9 Waste Import: Yes No <br /> (!f yes,complete Waste Import Supptement) <br /> C. GENERAL MATERIAL&REGULATORY INFORMATION <br /> 1. Common name: Solid Household Soaps,Cleaners,Degreaser,Detergents Commodity Pack <br /> 2. Process generating: <br /> Site Clean UplDiscarding Old Unused Materials <br /> 3. Describe physical appearance: <br /> Solid Materials in Containers <br /> 4. Odor: ❑None ®Slight E]Strong S. Physical State: ❑Liquid ❑Sludge/Slurry [Z]Solid <br /> 6. Describe Calor: Varies 7. Liquid phases: []Single ❑Double Layer []multi-layer <br /> 8. Knowledge is from: ❑Lab analysis ❑MSDS ❑� Process/generator knowledge <br /> 9. Waste/Material Type(US Ecology Texas customers only): ❑ N/A []Industrial ❑Nan-Industrial <br /> 10. Restricted under EPA Land Disposal Restrictions(§268)7 ❑Yes ❑No <br /> 11. If UDR"Yes": ❑Wastewater ❑Non-wastewater ❑Debris(§268.2) 1 12. Alt.Standards for soil? ❑Yes ®No <br /> 13. Is the material RCRA hazardous waste containing benzene and originating at a Petroleum Refinery(SIC 2911),Chemical <br /> Manufacturing Plant(SIC 2800 thru 2899)or Coke by-Product Recovery Plant(SIC 3312)? (if yes,complete Benzene ❑Yes ❑No <br /> Waste/Material Operations Supplement Form and Thermal Supplement Form): <br /> 14. VO Conc.(§264.1083): ❑<500 ppmw ❑z500ppmw IS. Has it been treated after point of generation? ❑Yes ❑No <br /> 16. CERCLA Regulated(Superfund)Waste: ❑Yes ❑No 17. Butadiene waste regulated by§63 Subpart XX: ❑Yes ❑No <br /> 18. Waste contains UHC constituent(s)(§268.48),above a treatment standard,other than those for which the waste exhibits a ❑Yes ❑No <br /> characteristic. (if yes,list all UHC's in Section D): <br /> 19. Waste exempt from definition of"solid waste"or"hazardous waste" (if yes,list reference 40CFR ): ❑Yes ❑No <br /> 20. State Waste Codes: 331 <br /> 21. RCRA Waste Codes: <br /> 22. Source Code: N/A 23. Form Code: N/A 24. Management Code: H (USE only) <br /> Revision date:06/24/16 Page 1 <br />