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WASTE/MATERIAL PROFILE FORM <br />US Ecology Nevada(Beatty)800-239-3943 <br />US Ecology Idaho (GrandView)800-274-1516 <br />US Ecology Texas (Robstown)800-242-3209 <br />US Ecology Michigan (Detroit)800-396-3265 <br />Ref. ID #:7-BW2EB <br />PROFILE #: <br />A. GENERATOR INFORMATION <br />1. Generator:ALEX GLAROS Billing Information is same.P.O required <br />2. Facility Address: 15271 MOORE RD.11. Customer FREMOUW ENVIRONMENTAL SERVICES <br />LODI, CA 95242 12. Billing Company:FREMOUW ENVIRONMENTAL SERVICES <br />3. Mailing Address:500 MAIN ST.13. Billing Address:6940 TREMONT ROAD <br />4. City/State/Zip:WINTERS, CA,95694 14. City/State/Zip:DIXON, CA,95620 <br />5. Technical Contact:ALEX GLAROS 15. Billing Contact:ANGELA BIASI <br />6. Phone:(530) 848-5149 7. Fax:16. Phone:(707) 635-7949 17. Fax (707) 448-3499 <br />8. Generator Status:VSQG/CESQG SQG LQG N/A 18. Email:ap@hazwasteremoval.com <br />9. EPA ID#:19. State ID#:CAC003280894 <br />10. NAICS/SIC Codes:339999 <br />B. SHIPPING INFORMATION <br />1. DOT Shipping Name:NA3082, HAZARDOUS WASTE LIQUID, N.O.S., <br />Not Otherwise Specified (Waste or Chemical ):LEAD, COPPER <br />2. Primary / Secondary Haz Class : 9 / 3. UN/NA # :NA3082 4. Packaging Group : III 5. RQ : <br />6. Container Type:Bulk Totes Pallet Boxes Drums Other, Desc <br />7. Frequency:Year Quarterly Monthly 1 Time Other, Desc AS NEEDED <br />8. Shipment:Size:275 Quantity:2 9. Waste Import:Yes No <br />(If Yes, Complete Waste Import Supplement) <br />C. GENERAL MATERIAL & REGULATORY INFORMATION <br />1. Common name :HAZARDOUS WASTE LIQUID <br />2. Process generating :CLEANING OUT AN UNDERGROUND STORAGE TANK <br />3. Describe physical appearance :LIQUID WASTE <br />4. Odor :None Slight Strong 5. Physical State Liquid Sludge/Slurrry Solid <br />6. Describe Color 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 (Robstown Facility Customers Only)N/A Industrial Non-Industrial <br />10. Restricted under EPA and Land disposal Restrictions (§268) ?Yes No <br />11. If LDR "Yes" :Wastewater Nonwastewater Debris 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 2322)? (If Yes complete Benzene <br />Waste/Material Operations Supplement form and Thermal Supplement form): <br />Yes No <br />14. VO Conc (§264.1083):<500ppmw ш500ppmw 15. 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 <br />characteristic. (If yes, list all UHC's in Section D): <br />Yes No <br />19. Waste exempt from definition of "solid waste" or "hazardous waste" (if Yes,list reference 40 CFR ):Yes No <br />20. State Waste Codes:132 <br />21. RCRA Waste Codes:D006 D007 D008 <br />22. Source code:G15 23. Form Code:W119 <br /> Revision date: 11/1/16