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| Approval Status | Approved |
|---|---|
| Access Code | koFv52KewB |
| Legacy ID | 16854 |
| Product Code | A1-SP |
| Expiration Date | 2026/10/15 |
| Top Cards | |
| A. General Information | A. General Information |
| Generator Name | Sutter Santa Rosa Regional Hospital DBA Sutter West Bay Hospital |
| Generator Site Address | 30 Mark West Springs Rd |
| City | Santa Rosa |
| ST | CA |
| Zip | 95403 |
| Generator Mailing Address: | 30 Mark West Springs Rd |
| City | Santa Rosa |
| ST | CA |
| Zip | 95403 |
| Phone No | 5593138200 |
| Generator EPA ID Number | CAL000398787 |
| Generator Contact | VINCENT MOODY |
| Bill to Company | ATLAS ENVIRONMENTAL SOLUTIONS |
| Bill to Contact | VINCENT MOODY |
| Bill to Address | PO BOX 4897 Fresno, CA 93744 |
| Email (notification sent to this email) | Email hidden; Javascript is required. |
| B. Description of Waste | B. Description of Waste |
| Generator's Common | Generator's Common |
| Name of Waste | RENALIN |
| Process Generating Waste | DISCARDING EXPIRED CHEMICALS |
| C. Manifest and Labeling Information: | C. Manifest and Labeling Information: |
| UN/NA No | UN3149 |
| Proper DOT Shipping Name | UN3149, Waste Hydrogen peroxide and peroxyacetic acid mixtures, stabilized [with acids, water and not more than 5 |
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| EPA Waste No |
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| State Waste No | 141 Off-specification, aged, or surplus inorganics |
| Haz Class | 5.1 (8) |
| PG | II |
| D. Characteristics of Waste: | D. Characteristics of Waste: |
| Color | CLEAR |
| Odor | STRONG |
| Flash Point | >142 |
| Physical State at 70 F | Single Phase Liquid |
| pH | 1 |
| Comments | California |
| E. Select Generic Waste Type that best describes Waste | Select Generic Waste Type that best describes Waste |
| F. Metals Total PPM: | E. Metals Total PPM: |
| % | % |
| Chemical Composition | (Please list all constituents in the material. Ranges are ok as long as they equal a minimum of 100%) |
| Percentage-1 | 0-5 |
| Chemical-Composition-1 | ACETIC ACID |
| Percentage-2 | 22 |
| Chemical-Composition-2 | HYDROGEN PEROXIDE |
| Percentage-3 | 0-5 |
| Chemical-Composition-3 | PERACETIC ACID |
| Percentage-4 | 64 |
| Chemical-Composition-4 | WATER |
| H. Anticipated Annual Volume: | H. Anticipated Annual Volume: |
| Quantity | 55 GAL |
| Quantity Option | closure |
| Container Type (Select all that apply) |
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| I. Special Handling or Additional Information: | I. Special Handling or Additional Information: |
| Phibro-Tech cannot process line | SAMPLE REQUIREMENT NOTICE: In accordance with Phibro-Tech’s RCRA Part B permit Waste Analysis Plan requirements, a representative sample of the waste stream must be submitted with all profiles for analysis. Samples should must be sent to: Phibro-Tech, Inc 8851 Dice Road, Santa Fe Springs, CA 90670, Attention: Customer Service |
| PFAS Screening | PFAS Screening The Los Angeles County Sanitation District (LACSD) now requires Phibro-Tech, Inc to screen all waste streams for PFAS (Perfluoroalkyl and polyfluoroalkyl substances). Specific waste streams identified by LACSD that require a PFAS analysis include:
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| PFAS Question | |
| Does this waste fall into one of the above 3 categories? | No |
| J. I hereby certify | I hereby certify that through generator knowledge and/or chemical analysis, all information submitted in this and all attached documents is complete, accurate, and that all known or suspected hazards have been disclosed. I also certify that the sample submitted with this document was collected using the appropriate sampling technique, so as to be representative of the actual stream. I also certify that the sample is properly classified, packaged, marked, and labeled and that the package is in proper condition for transportation according to DOT regulations. I also certify that this waste stream contains less than 10% organics and less than 500 parts per million (ppm) of volatile organic compounds (VOCs). |
| Authorized Name | Nicole McNeil |
| Title | OM |
| Date | 2025/09/30 |
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| PDF Content | |
| Link to Edit Entry | Edit Entry |
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