A02_28_Current_Waste_Profile_0001.pdf

QUESTIONS? CALL 800 963 4776 FOR ASSISTANCE Revised February 20, 2023 © 2023 WM Intellectual Property Holdings, L.L.C.

Requested Facility: Unsure Profile Number:

Multiple Generator Locations (Attach Locations) Request Certificate of Disposal Renewal? Original Profile Number:

A. GENERATOR INFORMATION (MATERIAL ORIGIN)

1. Generator Name:

2. Generator Site Address:

(City, State, ZIP)

3. County:

4. Contact Name:

5. Email:

6. Phone: 7. Fax:

8. Generator EPA ID:

9. State ID:

N/A N/A

B. BILLING INFORMATION SAME AS GENERATOR

6. Fax:

C. MATERIAL INFORMATION

1. Common Name:

Describe Process(es) Generating Material: See Attached

2. Material Composition and Contaminants: See Attached

1.

2.

3.

4.

Total comp. must be equal to or greater than 100% ≥100% N/A3. State Waste Codes:

4. Color:

5. Physical State at 70˚F: Solid Liquid Other:

to 6. Free Liquid Range Percentage:

7. pH: to

N/A N/A

8. Strong Odor: Yes No Describe:

9. Flash Point: <140˚F 140˚–199˚F ≥200˚ N/A

D. REGULATORY INFORMATION

Yes* No

Yes No

1. EPA Hazardous Waste?

Code:

2. State Hazardous Waste?

Code:

3. Is this material non-hazardous due to Treatment, Delisting, or an Exclusion?

4. Contains Underlying Hazardous Constituents?

5. Does the material contain benzene?

6. Facility remediation subject to 40 CFR 63 GGGGG?

7. CERCLA or State-mandated clean-up?

8. NRC, State-regulated, NORM or TENORM waste?

*If Yes, see Addendum (page 2) for additional questions and space.

E. ANALYTICAL AND OTHER REPRESENTATIVE INFORMATION

1. Analytical attached Yes

2. Other information attached (such as SDS)? Yes

F. SHIPPING AND DOT INFORMATION

N/A

Name (Print):

Certification Signature

EZ Profile™

1. Billing Name:

2. Billing Address:

(City, State, ZIP)

3. Contact Name:

4. Email:

5. Phone:

7. P.O. Number:

8. Payment Method: Credit Account Cash Credit Card at Gate

Yes* No

Yes* No

Yes* No Yes* No

Yes* No Yes* No

If Yes:

Yes No

9. Contains PCBs? If Yes, answer a, b and c.

a. Regulated by 40 CFR 761?

b. Remediation under 40 CFR 761.61?

c. Were PCBs imported into the US?

10. Regulated and/or Untreated Medical/Infectious Waste?

11. Contains Asbestos?

Non-Friable Non-Friable - Regulated

12. Contains Dioxins? (If Yes, please attach analysis)

Yes No Yes No Yes No

Yes No

Yes No

Yes No

1.

Yards Tons

Friable Yes No

One-Time Event Repeat Event/Ongoing Business

Yes* No

By signing this Waste Management (“WM”) Profile, I hereby certify that all information submitted in this and all attached documents contain true and accurate descriptions of this material, and that all relevant information necessary for proper material characterization and to identify known and suspected hazards has been provided. Any analytical data attached was derived from a sample that is representative as defined in 40 CFR 261 - Appendix 1 or by using an equivalent method. All changes occurring in the character of the material (i.e., changes in the process or new analytical) will be identified by the Generator and be disclosed to WM prior to providing the material to WM. I am aware that there are significant penalties for knowingly submitting false information.

2. Estimated Annual Quantity/Unit of Measure:

Drums Gallons Other

3. Container Type and Size:

4. USDOT Proper Shipping Name

5. Estimated Start Date

6. Transportation Needed?

Title:

Company:

Date:

G. GENERATOR CERTIFICATION (PLEASE READ AND CERTIFY BY SIGNATURE)

I am authorized to sign on behalf of the Generator and I have confirmed with the Generator that information contained in this profile, as well as supporting documents provided, are accurate and complete.

I am a duly authorized employee of Generator holding a position of technical responsibility with direct knowledge of the waste stream and the information contained in this profile, and I confirm that information contained in this profile, as well as supporting documents are accurate and complete.

Please identify Lab Report(s) and list specific representative Sample ID#s:

Greater Wenatchee Regional Landfill

1180 Umptanum Rd Ellensburg WA 98926

Kittitas Wendy Christensen gchristensen@usbr.gov

(509) 575-5848 x200

Bureau of Reclamation 1917 Marsh Rd Yakima WA 98901 Wendy Christensen gchristensen@usbr.gov

(509) 575-5848 x200

Contaminated Dirt & Debris

Contaminated soil from buried drums at a remediation site

Contaminated dirt & debris 100 %

WAH000059820

brown, gray

7 7

Analytical Laboratories Inc Laboratory Analysis Report Lab Federal ID# ID00020 Lab/Sample Number: 2310410-01, 2310410-02, 2310410-03, 2310410-04

22' x 4.3' x 8.6' rolloff bin

118264WA

Bureau of Reclamation

10/16/2023

Only complete this Addendum if prompted by responses on EZ Profile™ (page 1) or to provide additional information. Sections and question numbers correspond to EZ Profile™.

Profile Number:

C. MATERIAL INFORMATION

Describe Process Generating Material (Continued from page 1): If more space is needed, please attach additional pages.

Material Composition and Contaminants (Continued from page 1): If more space is needed, please attach additional pages.

5.

6.

7.

8.

9.

Total composition must be equal to or greater than 100% ≥100%

D. REGULATORY INFORMATION

Only questions with a “Yes” response in Section D on the EZ Profile™ form (page 1) need to be answered here.

1. EPA Hazardous Waste

a. Please list all USEPA listed and characteristic waste code numbers:

Yes No Yes No Yes No

b. Is the material subject to the Alternative Debris standards (40 CFR 268.45)?

c. Is the material subject to the Alternative Soil standards (40 CFR 268.49)? If Yes, complete question 4.

d. Is the material exempt from Subpart CC Controls (40 CFR 264.1083)?

If Yes, please check one of the following:

Waste meets LDR or treatment exemptions for organics (40 CFR 264.1082(c)(2) or (c)(4)) Waste contains VOCs that average <500 ppmw (CFR 264.1082(c)(1)) – will require annual update.

2. State Hazardous Waste Please list all state waste codes:

3. For material that is Treated, Delisted, or Excluded Please indicate the category, below:

Delisted Hazardous Waste Treated Hazardous Waste Debris

Excluded Waste under 40 CFR 261.4 Specify Exclusion:

Treated Characteristic Hazardous Waste If checked, complete question 4.

4. Underlying Hazardous Constituents Please list all Underlying Hazardous Constituents:

Yes No

Yes No ppmw

<1 Mg 1–9.99 Mg ≥10 Mg Yes No

Yes No

Yes No Yes No

Yes No

Yes No

EZ Profile™ Addendum

QUESTIONS? CALL 800 963 4776 FOR ASSISTANCE Revised February 20, 2023 © 2023 WM Intellectual Property Holdings, L.L.C.

e. Form Code: f. Source Code:

5. a. Are you an industry regulated under Benzene NESHAP? (Petroleum refineries, chemical manufacturing plants, coke by-product, and TSDFs.)

b. Are you a TSDF? If yes, please complete Benzene NESHAP questionnaire. If not, continue.

c. What is the flow weighted average benzene concentration?

d. What is your facility’s current total annual benzene quantity in Megagrams?

e. Is this waste soil from a remediation?

1. If yes, what is the benzene concentration in remediation waste?

f. Does the waste contain >10% water/moisture?

g. Has material been treated to remove 99% of the benzene or to achieve <10 ppmw?

h. Is material exempt from controls in accordance with 40 CFR 61.342?

If yes, specify exemption:

i. Based on your knowledge of your waste and the BWON regulations, do you believe that this waste stream is subject to treatment and control requirements at an off-site TSDF?

State-Regulated Radioactive Technologically Enhanced Naturally Occurring Radioactive Material (TENORM) Naturally Occurring Radioactive Material

b. Testing, per individual waste stream, for applicable isotopes and/or other supporting information attached? Yes No ppmw

6. 40 CFR 63 GGGGG Does the material contain <500 ppmw VOHAPs at the point of determination?

7. CERCLA or State-Mandated clean up Please submit the Record of Decision or other documentation with process information to assist others in the evaluation for proper disposal. A “Determination of Acceptability” may be needed for CERCLA wastes not going to a CERCLA approved facility.

8. NRC, State-regulated radioactive, NORM or TENORM?

a. Please select all that apply:

Nuclear Regulatory Commission (NRC) Radioactive

118264WA

1,4-Dichlorobenzene 1,3-Dichlorobenzene 1,2-Dichlorobenzene 1,2,4-Trichlorobenzene Phenanthrene Pyrene Di(2-ethylhexyl)phthalate Barium