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neha.gaur@pahc.com

July 2, 2026

Approval Status

Rejected

PURCHASE ORDER #

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Access Code

8UdRJ4Qg48

Legacy ID

17353

ERS No.

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Top Cards

Send Samples To:

Phibro-Tech Inc.

8851 Dice Road

Santa Fe Springs, CA 90670

A. General Information

A. General Information

Generator Name

Acton Strickland

Generator Site Address

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City

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Zip

87663

Generator Mailing Address:

PO Box 36541

City

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Zip

14949

Phone No

+1 (536) 619-3429

Fax No

+1 (423) 856-6351

Generator EPA ID Number

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Generator Contact

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Bill to Company

Robinson and Medina Inc

Bill to Contact

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Bill to Address

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Email (notification sent to this email)

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B. Description of Waste

B. Description of Waste

Generator's Common

Name of Waste

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Process Generating Waste

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C. Manifest and Labeling Information:

C. Manifest and Labeling Information:

UN/NA No

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Proper DOT Shipping Name

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EPA Waste No

D001 Ignitable – DOT Oxidizers
D002 Corrosive
D004 Arsenic
D005 Barium
D006 Cadmium
D007 Chromium
D010 Selenium
D011 Silver

State Waste No

792 Liquids with pH ≤ 2 with metals

Haz Class

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D. Characteristics of Waste:

D. Characteristics of Waste:

Color

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Odor

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Specific Gravity@70 F

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Flash Point

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Physical State at 70 F

Cake

Comments

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E. Select Generic Waste Type that best describes Waste

Select Generic Waste Type that best describes Waste

Select Generic Waste Type that best describes Waste

IB (94, 103, 104) - Misc Bases with or without metals

F. Metals Total PPM:

E. Metals Total PPM:

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Cr3+

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Cr6+

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Chemical Composition

(Please list all constituents in the material. Ranges are ok as long as they equal a minimum of 100%)

Percentage-1

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Chemical-Composition-1

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Percentage-2

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Chemical-Composition-2

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Percentage-3

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Chemical-Composition-3

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Percentage-4

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Chemical-Composition-4

Sunt ea repellendus

Percentage-5

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Chemical-Composition-5

Voluptatum vero volu

Percentage-6

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Chemical-Composition-6

Totam nostrud mollit

Percentage-7

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Chemical-Composition-7

Pariatur Duis dicta

Percentage-8

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Chemical-Composition-8

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H. Anticipated Annual Volume:

H. Anticipated Annual Volume:

Quantity

490

Quantity Option

onetime

Container Type (Select all that apply)

Drum
Tote

I. Special Handling or Additional Information:

I. Special Handling or Additional Information:

Special Handling or Additional Information:

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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:

Any amount of aqueous film forming foam (AFFF) such as fire-fighting water, fixed fire extinguishing system test water, and/or contaminated groundwater.
Process, rinse, and/or waste solutions containing hexavalent chromium (chrome VI or Cr(VI)) from chrome plating operations.
Any other waste streams that are known or suspected to contain excessive quantities of PFAS.

PFAS Question

Does this waste contain PFAS?

Does this waste fall into one of the above 3 categories?

Yes

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

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Title

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Date

2026/06/02

PDF Footer

For further inquiries, contact PTIService@pahc.com

PDF Header

Corporate Office: Glenpointe Center East, 3rd Fl, 300 Frank W. Burr Blvd Ste 21, Teaneck, NJ 07666-6712 · (201) 329-7300

SEND SAMPLES TO: Phibro-Tech, Inc. 8851 Dice Road Santa Fe Springs, California 90670 · (800) 777-1850

PDF Content

Date: {TD}

Dear Customer,

Congratulations, the following profile has been approved for recycling at Phibro-Tech, Inc. under our Environmental Recovery Service (ERS). We appreciate the opportunity to manage this material for you.

Generator Name: {GeneratorName}

Waste Name: {WasteName}

ERS (Profile) Number: {ERS}

Expiration Date: {ExpirationDate}

Price Code: {PriceCode}

The following pricing will apply
{Pricing}

Standard Pricing Rules:

1) Resource & Recovery Fee of 20% applied to every billable order.

2) All Disposal pricing is FOB Phibro-Tech Inc., 8851 Dice Rd. Santa Fe Springs, CA. 90670.

3) Non standard container sizes are billed as special pricing.

4) Profiles are priced at the time of profile approval.

5) Pricing to be reviewed at profile renewal.

6) All disposal is via Wastewater Treatment unless otherwise specified.

7) $100 minimum fee per manifest.

8) $35 Manifest fee per manifest.

9) IBC's with < 225 gallons will be billed at 225 gallons.

10) $50 surcharge per non-conforming container including totes, overpacks, and broken pallets.

11) $15 per drum if not on pallets.

12) $400 per drum for offsite disposal of drums with solids.

13) $100 surcharge for IBC’s with significant solids.

14) $100 per labor hour per person for non-standard waste off-loading work.

15) $250 fee for unscheduled loads, no show for scheduled or reoccurring loads, or same day cancellation.

16) $250 Emergency profile fee for new or expired wastes that need to be sampled on arrival.

17) Safety Surcharge for high risk waste streams requiring extra handling or waste streams with free chlorine: Bulk $4,000 /Tote $1,000. Drums based on tiered sizes largest to smallest: $400/$300 /$200 /$100

18) Spent ammonia and cupric non-conforming charge: $1.00/gallon Nickel > 50 PPM or Iron > 200 ppm.

19) $250 for weekend scheduling based on PTI availability.

PHIBRO-TECH, INC HAS THE APPROPRIATE PERMIT(S) FOR, AND WILL ACCEPT, THE HAZARDOUS WASTE APPROVED UNDER THIS PROFILE.

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