Profile Number
Approval Number
Recertification
Current Number
Date Submitted
Date Approved
Santa Maria Sanitary Landfill
Generator Waste Profile
 Yes  No
Phone: 805-346-6591 Fax: 805-346-6127
Profile contact: Dan Vossler Email: dan@tracer-est.com
Important: The generator or authorized representative of the generator must complete this profile in full. Please attach any additional
information requested. SMSL accepts waste shipments only after waste profiling and approval.
Section 1 – Generator Information
Generator Name _____________________________________
Company Representative _________________________
Facility Name ________________________________________
Title ___________________________________________
Industry _____________________________________________
Emergency Contact ______________________________
Facility Address _____________________________________
Facility Phone ___________________________________
City ________________________________________________
After hours number _____________________________
County ______________ State _______ Zip ____________
Emergency number ______________________________
Section 2 – Waste Description
General Waste Description __________________________________________________________________________________
Specific Generating Process/Site History _______________________________________________________________________
Has waste been mechanically screened? _______________________If yes, to what size?________________________________
Estimated waste volume: _________________  Tons  Cubic Yards  Gallons  Drums  Other ______________________
Frequency:  Single Event  Day  Week  Month  Year  Other __________________________________________
Transported by:  Roll off box  Dump truck  Drum (type/size) __________________________________
Other: ____________________________________________________________________________________________________
Section 3 – Waste Properties (at room temperature, check all that apply)
 Solid
 Semi solid
 Sludge
 Filter cake
Color(s) _____________________ Sheen  Yes  No
 Powder
 Liquid
 Soil
 Debris
Percent solids ____________________________________
 Concrete
 Wood
 PPE
 ____________
Flash point ?F _____________________________________
Phases:  Single  Bi-layer  Multi-layered ______
pH range _____ to _____
Asbestos > 1%  Yes  No
Odor  None  Mild  Strong
Describe ________
__________________________________________________
Section 4 – Transportation (complete all items. If item is not applicable, use ‘NA’)
Is this waste a DOT Hazardous Waste
 Yes  No
Transporter ______________________________________
Proper US DOT Shipping Name _______________________
Technical Contact ________________________________
US DOT Hazard Class ________________________________
Phone ___________________________________________
Section 5 – Insurance
If the Generator is providing for its own transportation of NHIS then, prior to initiating disposal activities, the Generator, or its
transporter, shall furnish Certificates of Insurance evidencing that the Generator, or its transporter, has insurance covering its liability
under Workers Compensation and Comprehensive General Liability. Insurance shall be maintained in full force until disposal
activities at the City of Santa Maria Landfill are completed. Contractor agrees to indemnify and hold harmless the City of
Santa Maria and Central Coast Remedial Resources, Inc. against any claims, actions or demands against them, and against
any damages, liabilities or expenses, including attorney fees, for personal injury or death or for loss or damage to property,
Santa Maria Sanitary Landfill
Generator Waste Profile
Page 2 of 3, Phone No. 805-346-6591
FAX 805-346-6127, Email dan@tracer-est.com
arising out of or in connection with the transportation operations of NHIS. In addition, the City of Santa Maria and Central
Coast Remedial Resources, Inc. shall be named as “Additional Insured” on said policy, by endorsement, and a statement
from the insurer that providing that no coverage will be cancelled or materially changed without at least thirty (30) days
advance written notice to the City of Santa Maria. Minimum limits for Comprehensive General Liability Insurance for personal
injuries (including death) shall be $1,000,000 per occurrence. Minimum limits shall be $1,000,000 per accident for automobile liability
insurance covering bodily injuries (including death) and $1,000,000 per occurrence for property damage.
Section 6– Analysis (analysis must be performed by a California State Certified Laboratory)
Waste Analysis Attached (Check all that apply)
Volatile Organics
 Semi-volatile Organics
 TPH Gas/Diesel
 BTX
 Herbicides/Pesticides
 TRPH
 PCB’s  DI Wet
 CA Title 22 Metals
 Other ______________________
Section 7 – Generator Knowledge, and Certifications
1. Is this a hazardous waste defined by RCRA, 40 CFR
Part 261 or 22 CCR Article 11?
 Yes  No
2. Is the waste from a non-specific source listed in 40
CFR Part 261.31 (F Codes)?
 Yes  No
3. Is the waste stream from a specific source listed in
40 CFR Part 261.321 (K Codes)?
 Yes  No
4. Is the waste from a discarded chemical product, off
specification species, container residue and/or spill
residue listed in 40 CFR Part 261.33 (P Codes and
U Codes)?
5. Does the waste have any hazardous characteristic
listed in 40 CFR Part 261 Subpart C (D codes)?
Waste determination based on (check all that apply)
Generator Certification
 Yes  No
 Yes  No
6. Is the waste specifically excluded from hazardous
waste regulation in 40 CFR Part 261.4? If so,
please attach an explanation including the
specific exclusion in 40 CFR Part 261.4.
 Yes  No
7. Is the waste mixed with a hazardous waste?
8. Is the waste being legally treated for a single
hazardous characteristic? If so attach an
explanation.
9. Has the waste ever been ‘handled’ or ‘disposed’ of
as a hazardous waste, material, or via a Uniform
Hazardous Waste Manifest? If so, please attach
an explanation.
 Independent Analysis
 MSDS
 Yes  No
 Yes  No
 Yes  No
 Knowledge of Process/
 Other (explain) ___________________________________________________________________
Section 8 – Billing Information
Bill to ____________________________________________
Fax No. ____________________________________________
__________________________________________________
PO No. _____________________________________________
__________________________________________________
Job No/Name ________________________________________
Attention: ________________________________________
Salesman ___________________________________________
Phone No. ________________________________________
Price Quote _________________________________________
Santa Maria Sanitary Landfill
Generator Waste Profile
Page 3 of 3, Phone No. 805-346-6591
FAX 805-346-6127, Email dan@tracer-est.com
I hereby certify that I am authorized by the Generator identified herein to provide the information submitted on this form and any attached
documents and enter into this agreement on the generator’s behalf; that I have made a complete and thorough investigation of all matters
relevant to the completion of this form, that, to the best of my knowledge, all information supplied is truly representative of the above mentioned
waste and that all known or suspected hazardous constituents, or safety hazards associated with have been disclosed herein. I agree to notify
SMSL if there is any change in the waste stream information submitted for acceptance. I also certify that all samples were collected according
to EPA Method SW 846, that samples were analyzed by a California State Certified Lab and that appropriate chain of custody was attached. I
further certify that the wastes submitted for disposal are non-hazardous in accordance with California Health and Safety Code, and the Code of
Federal Regulations and any applicable local laws or regulations. The generator of the non-hazardous hydrocarbon impacted soil (NHIS)
retains responsibility for the composition of the material. If any soils delivered to SMSL are found to be “hazardous waste” the customer shall be
solely responsible for its removal. If the customer fails to remove such soils, SMSL, acting as the customer’s agent, may arrange for such
removal at the customer’s expense.

Self Certification I have based this waste determination of the knowledge of the waste generating process and I certify that the waste
contains no constituents that would necessitate analytical testing to determine that waste is nonhazardous process as per Title 22 CCR
66261.10 (a)(2)(B).

Annual Recertification This is an annual rectification of an existing profile. I certify that either; the waste generating process has not changed
and therefore I have not reanalyzed the waste, or I have reanalyzed the waste and have attached copies to this form.
Name (print) ______________________________________
Company ___________________________________________
Signature ________________________________________
Date _______________________________________________
For City of Santa Maria Use Only
Waste
 Approved
 Rejected by ________
________
Comments: ____________________________________
_________________________________________________________________________________________________________
Generator Waste Profile
Revision 1
October 18, 2004