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HomeMy WebLinkAboutContract 45320 (2)FORT WORTH® „mar i CITY OF FOR11' C0 D II G ES Jl ION FE JKD STOCK OCK a D EL]V I►+,R Y AGREEMENT This A reement, is entered into this115- �'- 2 of 20 i Lfand between the gday by City of Fort Worth (CITY),, by and through its duly authorized Assistant City Manager, Fernando Costa a d /2-11E, (1026 6 (Hauler), by and through its duly authorized WHEREAS, the CITY's Village Creek Water Reclamation Facility (VCWRF) located at 4500 Wilma Lane, Arlington, Texas, has the capability to accept and process organic waste, grease and food waste that meet the testing characteristics set by the City (collectively referred to as Co -digestion Feed Stock) and; WHEREAS, Hauler would like to dispose of its Co -digestion Feed Stock at the VCWRF. NOW THEREFORE, in consideration of the mutual promises and benefits of this agreement, the CITY and Hauler agree as follows: CONTENT OF THE JASTE 1. For the purposes of this agreement, Coodigestion Feed Stock shall mean Moo degradable, nontoxic organic waste amenabile to annerrobIlk digestlorrll as de terr mf ned by the (C II T Yo 2. Hauler may only deliver e to the VCWRF Cogeneration facility materials as approved and shown on the Generator Waste Profile Sheet attached as Exhibit A to this agreement. Hauler shall obtain the signature of the generator on the Generator Waste Profile sheet prior to the any disposal at the VCWRF. 3. A Hauler may not discharge any material which may, for any reason contain hazardous waste as defined by the Resource Conservation and Recovery Act, 42 USC Section 6901 et. seq, nor any hazardous substances as defined in the Comprehensive Environmental Response, Compensation and Liability Act, 42 USC Section 9601 et. seq., nor any material that contains any amount of material of unknown origin which may itself, or in combination with other components cause a detrimental impact to the anaerobic digestion process. All material must be capable of being pumped through a 0.5 inch screen. Hauler may not deliver a =sue _d____materials RECEIV EE) JAN 2 9 2WF4 L :)ilLiscv SECRET ()Fmcialk. EC®Rt jll WoRrH, rf which alone or in combination with other material may cause obstruction or damage to the facility. 4. CITY may, at its sole discretion and without prior notice, refuse to accept at its facility and reject for processing any materials it deems may contain hazardous waste, or be incompatible for processing at the VCWRF. Acceptance of any materials by the CITY shall in no way limit the Hauler s liability for damages or violations of any applicable laws If waste accepted at the facility is tested and is proved is incompatible with the process, the Hauler shall remove the waste from VCWRF at the Hauler's expense If the City deems it necessary to remove the waste, the CITY may remove the Waste at the Hauler's expense. 5. For the purposes of determining the chemical, physical or biological characteristics of any material presented at its facility for discharging, CITY reserves the right, at its own expense to sample and analyze material prior to permitting its discharge or any time thereafter. The CITY has the right to inspect and sample facilities associated with the generation of accepted waste. CITY has the right to change the classification and any associated fees for waste delivered based upon the results of laboratory analyses performed on the waste sample. 6. No Waste will be accepted which may cause pass -through or interference for the CITY's utility or system. DISPOSAL RATES AND WASTE CLASSIFICATION RATES AND BILLING Rates shall be set by the City Council and may be amended from time to time. 8. Hauler will receive a bill from the CITY on a monthly basis. All bills must be paid within thirty (30) days from the date of the invoice. If the bill is not paid within (30) days from the date the bill is due, the agreement will be suspended until the payment is completed or make payment arrangements with CITY. TIME OF DISCHARGE, 9. The CITY shall accept Co -digestion teed Stock at the VCWRF for disposal Monday through Saturday in accordance with the schedule as coordinated through the Facility Superintendent, except as referred to in paragiaph 18 or in an emergency situation as defined by CITY. 10. It is the responsibility of the Hauler to discharge the Co -digestion Feed Stock into the receiving area set up to receive Co -digestion Feed Stock at the CITY facility. METHOD OF DISCHARGE 11. Prior to discharging any Co -digestion Feed Stock, the Hauler must check in and sign a delivery ticket (the "Ticket") The Ticket will state the: (a) date; (b) time; (c) name of Hauler; (d) origin and type of Waste being offered for disposal; (e) volume of the truck; (0 volume of Waste being offered for disposal; (g) name of the CITY representative accepting the ticket; (h) signature of driver delivering the waste. 12. The CITY will supervise the discharge of Co -digestion Feed Stock at the VCWRF and instruct the Hauler as to the rate of flow at which to discharge the Co -digestion Feed Stock. Discharge of Waste from truck must be pumped using the Hauler's own pump. Blowing off of waste is prohibited unless authorized in writing by the CITY. 13. No Co -digestion Feed Stock may be discharged into the septage receiving area. Prior to each truckload of waste being discharge, it is the responsibility of the Hauler to notify CITY personnel of its intent to discharge Co -digestion Feed Stock. Hauler will not discharge any Co -digestion Feed Stock until notified by CITY personnel to begin discharging. 14. The Hauler will be responsible for the clean-up and removal of any Co -digestion Feed Stock and other materials spilled by the Hauler on CITY property as well as Co -digestion not properly discharged by Hauler into the receiving area. 15. Prior to any delivery, the Hauler must attend a plant orientation class and be familiar with and comply with all CITY rules for the VCWRF Hauler shall adhere to all posted speed limits and safety rules at all times. INDEMNIFICATION 16. Hauler shall comply with all municipal, State or Federal environmental laws for the hauling and discharging of any and all waste. 17. A. For purposes of this agreement, the following words and phrases shall be defined as follows: 1. Environmental Damages shall mean all claims, judgments, damages, losses, penalties, fines, liabilities (including strict liability), encumbrances, liens, costs, and expenses of investigation and defense of any claim, whether or not such claim is ultimately defeated, and of any good faith settlement or judgment, of whatever kind or nature, contingent or otherwise, matured or unmatured, foreseeable or unforeseeable, including without limitation reasonable attorney's fees and disbursements and consultant's fees, any of which are incurred as a result of handling, collection, transportation, storage, disposal, treatment, recovery, and/or reuse of waste pursuant to this contract, or the existence of a violation of environmental requirements pertaining to, and including without limitation: a. Damages for personal injury and death, or injury to property or natural resources; b. Fees incurred for the services of attorneys, consultants, contractors, experts, laboratories and all other costs in connection with the investigation or remediation of such wastes or violation of environmental requirements including, but not limited to, the preparation of any feasibility studies or reports of the performance of any cleanup, remediation, removal, response, abatement, containment, closure, restoration or monitoring work required by any federal, state or local governmental agency or political subdivision, or otherwise expended in connection with the existence of such wastes or violations of environmental requirements, and including without limitation any attorney's fees, costs and expenses incurred in enforcing this contract of collecting any sums due hereunder; and c. Liability to any third person or governmental agency to indemnify such person or agency for costs expended in connection with the items referenced in paragraph 2of this part. 2. Environmental requirements shall mean all applicable present and future statutes, regulations, rules, ordinances, codes, licenses, permits, orders, approvals, plans, authorizations, concessions, franchises, and similar items, of all governmental agencies, departments, commissions, boards, bureaus, or instrumentalities of the United States, states, and political subdivisions thereof and all applicable judicial, administrative, and regulatory decrees, judgments, and orders relating to the protection of human health or the environment, including without limitation: a. All requirements, including, but not limited to, those pertaining to reporting, licensing, permitting, investigation, and remediation of emissions, discharges, releases, or threatened releases of hazardous materials, pollutants, contaminants or hazardous or toxic substances, materials, or wastes whether solid, liquid, or gaseous in nature, into the air, surface water, groundwater, stouiiwater, or land, or relating to the manufacture, processing, distribution, use, treatment, storage, disposal, transport, or handling of pollutants, contaminants, or hazardous or toxic substances, materials, or wastes, whether solid, liquid, or gaseous in nature; and b. All requirements pertaining to the protection of the health and safety of employees or the public B. GENERAL INDEMNIFICATION, HAULER DOES HEREBY RELEASE, INDEMNIFY, REIMBURSE, DEFEND, AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS, FROM AND AGAINST ANY AND ALL LIABILITY, CLAIMS SUITS, DEMANDS, OR CAUSES OF ACTIONS WHICH MAY ARISE DUE TO ANY LOSS OR DAMAGE TO PERSONAL PROPERTY, OR PERSONAL INJURY, AND/OR DEATH OCCURRING AS A CONSEQUENCE OF THE PERFORMANCE OF THISAGREEMENT, WHEN SUCH INJURIES, DEATH, OR DAMAGES ARE CAUSED BY THE NEGLIGENCE OFHAULER, ITS OFFICERS, AGENTS, OR EMPLOYEES, OR THE JOINT NEGLIGENCE OFHAULER, ITS OFFICERS, AGENTS, OR EMPLOYEES, AND ANY OTHER PERSON OR ENTITY. C. ENVIRONMENTAL INDEMNIFICATION: HAULER DOES HEREBY RELEASE, INDEMNIFY, DEFEND, REIMBURSE, AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS, FROM ANY AND ALL ENVIRONMENTAL DAMAGES AND THE VIOLATION OF ANY AND ALL ENVIRONMENTAL REQUIREMENTS RESULTING FROM THEHAULER'S TRANSPORTING OR DISPOSAL OF WASTE AND ALL RELATED ACTIVTIES UNDER THIS AGREEMENT. 18. CITY may in its sole discretion and without prior notice, refuse to accept the discharge of Co -digestion feed stock from Hauler at times of treatment plant upset, high influent flow conditions or for any other good cause as determined by CITY personnel. TERM AND TERMINATION 19. The term of this Agreement shall be for five (5) years from the date of full and complete execution. Upon mutual written amendment, this Agreement may be renewed for up to five (5) one (1) year term. 20. Either party may teitamate this agreement by giving thirty (30) days written notice to the other party. All indemnification provisions in the Agreement shall survive termination. INSURANCE REQUIREMENTS 21. The Hauler shall at its own cost and expense maintain, and shall cause its subcontractors to maintain insurance in the minimum amounts as set forth below. The Hauler shall name the City as an additional insured in its policies for the insurance coverage required herein and a certificate of insurance evidencing the required insurance coverage shall be filed by the Hauler with the CITY. The CITY shall be given 30 days written notice prior to termination or reduction of such insurance. The Hauler shall keep in force the following types of insurance in a company or companies acceptable to the CITY. A) Comprehensive General Liability Insurance Minimum Policy Limits of: $1,000,000.00 per occurrence / $2,000,000.00. Aggregate and must include Completed Operations Liability. Policy must be endorsed to show CITY as Additional Named Insured. B) Worker's Compensation and Employee's Liability Insurance covering all employees engaged directly and indirectly in the disposal of Waste at the CITY facility. Coverage is to comply with Texas Statutes and include coverage for Proprietors, Partners and/or Executive Offices. EMPLOYERS LIABILITY limits of $500,000.00 for each accident/disease required. C) Automotive and Other Vehicle Liability Insurance covering all, Combined Single Limit (CSL) owned, non -owned, and hired vehicles in the following minimum amounts: 1. Bodily Injury- 2. Property Damage $1,000,000.00 $1,000,000.00 D) Property Insurance The Hauler is required to insure his/her own Property. The CITY shall not provide any insurance on the Hauler's property. E) Additional Insured The Hauler shall name the CITY as an additional insured on the Certificate of Insurance. COST OF ENFORCEMENT 22. The Hauler shall reimburse CITY for all costs, including reasonable attorneys' fees and costs of suit, incurred by CITY in enforcing this Agreement as a result of the Hauler's violation of any provision of this Agreement. NOTICE 23. All invoices, notices, requests, demands and other communications herein shall be in writing and shall be deemed to have been duly given, if delivered via fax, in person or mailed by first class U.S. mail, postage pre -paid. City of Fort Worth Mr. Jerry Pressley, REM Village Creek Water Reclamation Facility Fort Worth Water Department 4500 Wilma Lane Arlington Texas 76012 Phone: 817-392 4926 VCWRF phone: 817-392-4920 INSERT COMPANY NAME (Company Name) gL /r/ %2see t (Address) //cj 5'Actc/i / e-czy,G (Phone) rit. `v��4 7609 LICENSING. TESTING AND MONITORING 24. The Hauler warrants that acquired and shall maintain all required State and Federal licenses and permits to haul waste. The Hauler shall be solely responsible at its own cost and expense for requirements mandated by the Texas Commission on Environmental Quality (TCEQ) and the United States Environmental Protection Agency (USEPA), or pursuant to any other local, municipal, State or Federal environmental law. Copies of any waste analysis reports or any other documentation sent to or from the TCEQ and USEPA shall be filed with the CITY. ENTIRE AGREEMENT 25. This Agreement represents the entire agreement between the parties and supersedes and nullifies any prior agreement. Any modification or addition to the agreement must be in writing signed by both parties. VENUE 26. Venue and jurisdiction of any suit, right, or cause of action arising under or in connection with this Agreement shall lie exclusively in Tarrant County, Texas. IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement this 7 day of 34V/, ,A.D.,20 / • CITY OF FO TWO Attest: City Approved as to Form and Legality: �Am, n Ms. Christa Reynolds Title: Sr. Assistant City Attorney . By: 4."--)sealum,4(44....... Mr. Fernando Costa Title: Assistant City Manager Reconln nded by: ebastian 'ichera REM Title: Asst. Dir. Water Resource covery Fort Worth Water Department (INSERT OMPANY AME) L L c- GiY! j� ctilt `dj By: Title: Date: • 441941 C P e/90/14 Date: Witness Date: '? ©fl 1L (DECOR ©fl V SECRETARY nfRTH, TX Date Entered:1/9/2014 DATE (MIWDDIYYYY) Policy Number: 1/9/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu o_ f such endorsement(s). PRODUCER Nelson Insurance Agency 2340 W. Interstate 20, Suite #202 Arlington, Tx 76017 INSURED Bio Liquid Materials Trucking, LLC DBA BIM Trucking 114 Shady Brook Ct Joshua, TX 76058 COVERAGES CERTIFICATE NUMBER: CONTACT LISA HULL (AX NC No. Ex": (81 7) 274-1445 �(AC Noj: (817} 795-7881 ADORess: lisa@ rniagency. com INSURER C INSURER D: INSURER E: INSURER F: INSURER(S) AFFORDING COVERAGE INSURER A: ESSEX INSURANCE CO. INSURER B; Carolina Casualty Texas Mutual Insurance Co. REVISION NUMBER: NAIC # THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDLTSUBR POLICY EFF ! POLICY EXP INSR I WVD POLICY NUMBER I (MM/DDM(W) , (MM/DDIYYYY) F$1,000,000 106/10/2013 06/10/2014 S 100,000 INSR LTR TYPE OF INSURANCE GENERAL LIABILITY A B C COMMERCIAL GENERAL LIABILITY CLAIMS -MADE GEML AGGREGATE LIMIT 1 POLICY JECCT AUTOMOBILE LIABILITY ANY AUTO r ALL OWNED :AUTOS HIRED AUTOS UMBRELLA LIAR EXCESS LIAR DED I I RETENTION S WORKERS COMPENSATION AND EMPLOYERS* LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER MEMBER EXCLUDED? (Mandatory in NH} if yes. desciibe under DESCRIPTION OF OPERATIONS below B 'CARGO OCCUR APPLIES PER I I LOG TIFI SCHEDULED AUTOS NON -OWNED AUTOS OCCUR I CLAIMS -MADE Y/N IN I F LIB ILI x N/A 3DK4794 CBP344728 TSF-0001217940 CBP344728 LIMITS 36/10/2013 06/10/2014 1/2013 [.1/11/2014 06/10/2013 p6/10/2014 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) DESCRIPTION OF OPERATIONS - TRUCKING EACH OCCURRENCE DAMAGE TO RENTED PREMI rSJEa occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG 000 1,000,000 2,000,000 5INCLUDED S COMBINED SINGLE LIMIT 1 000 000 (Ea accident) $r r BODILY INJURY (Per person) S S S BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE WC STATU- i OTH- TORY LIMITS F ER E.L. EACH ACCIDENT EL. DISEASE - EA EMPLOYEE El DISEASE- POLICY LIMIT BROAD FORM DEDUCTIBLE S S $ /000,000 $1,000,000 51,000,000 100,000 1,000 CERTIFICATE HOMER IS LISTED AS ADDITIONAL INSURED ON GENERAL LIABILITY & AUTO LIABILITY POLICIES. 30 DAY NOTICE OF CANCELLATION (OTHER THAN NON PAYMENT, 10 DAYS) OR MATERIAL CHANGE ON ALL POLICIES IN FAVOR OF CERTIFICATE HOLDER PER POLICY PROVISIONS/ENDORSEMENTS. CERTIFICATE HOLDER CITY OF FORT WORTH 4500 WILMA LANE ARLINGTON, TX 76012 ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /1 0111988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'roduced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800-208-1977 EXHIBIT A FORT WORTH® 4---"%astry G 11+;Nk,RATO ' S WASTIli; PROFILE SH ll+,F:i F O R THE Ca -DIGESTION PROCESS OCESS AT VILLAGE C +'11+',K W nTER RECLAM TION FACCIIEI,I'11'Y PLEASE PRINT IN INK OR TYPE Service Agreement on File? YES NO Profile Number: 1. Generator Name: Delek Renewable Fuels LLC 2. SIC Code: 2869 3. Phone: 817-558-9255 4. Facility Street Address: 3102-Windmill Rd 5. Facility City: Cleburne 6. State/Province: Texas 7. Zip/Postal Code: 76033 8. State: Texas 9. Contact information (Name and Phone number)_Frank Roy _ 817-558-9255 10. Billing Address: Same as above 11. What is the main operation, overall purpose of the site or facility? Biodiesel Production 1. Description (This must be completed for each type of waste) a. Nature of the Waste: Slop Oil from Biodiesel Production b. What is the process that generates the waste stream? Wash water used to purify the incoming fats and oils and finished biodiesel c. Physical state (Circle) • Liquid Sludge d. Layers (Circle) : Single C% 9 Multilayer e. Free liquid range : `,/2 to ; % f. What are the inputs into the process generating the waste? What chemical solutions (if any) have been added during the waste generation processes? What % concentration of chemical solutions exists in the waste generated? Please provide the appropriate Material Safety Data Sheets. Animal Fats, Vegetable oils glycerin, water and sodium hydroxide g• What are the constituents of concern (e.g., pH, COD, metals, hydrocarbons, etc)? Submit appropriate laboratory test results: Parameter COD Total Solids Volatile Solids Arsenic Cadmium Chromium Copper Lead Nickel Silver Mercury Zinc Cyanide Sulfate Conductivity TPH ( SGTHEM) pH* Acceptable range in mg/L > 60,000 4% to pumpable at room temperature High volatile/low residuals < 0.25 < 0.15 < 5.00 < 4.00 < 2.9 < 2.00 < 1.00 < 0.01 < 5.00 < 1.0 <500 mg/L Reporting the data is required Reporting the data is required 5 to 8 Result in mg/L *low pH for the waste will be considered if the low pH is due to the presence of organic acids m the waste (Examples* Lactic acid, Acetic acid, Formic acid, Citric acid) Preserving natural resources in a changing world" INC.EM Environmental Chemistry & Compliance Specialists- TALEM ENVIRONMENTAL SERVICES 610 SOUTH JENNINGS AVENUE FORT WORTH, TX 76104 TEL: (817) 336-1186 FAX: (817) 335-9830 Attention: Gary Lee BLM Trucking 114 Shady Brook Ct. Joshua ,TX 76068 Client Acct No: 5533 TALEM Lab ID No: 140110002-001 Sample Matrix: Liquid Analyte S ulfate Arsenic Cadmium Chromium Copper Lead N ickel S liver Zinc Mercury S pecific Conductance @ 25C Cyanide Total Total Volatile Solids * pH Chemical Oxygen Demand TPH (C 6 to C12) TPH (C>12 to C28) TPH (C>28 to C35) TPH (C6 to C35) Total TPH ANALYTICAL REPORT (Draft Report) •: . r4r4f. Customer Project: Customer Sample ID: Wet/Glycerin Collected. By: Gary Lee/Cst. Result Dltn Test Unit Fctr Procedure mg/L 1 ASTM D516-90 mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C mg/L 1 EPA 6010C pg/L 1 EPA 7470A 2000 pmhos/cm 1 EPA 9050a mg/L 1 Lachat 10-204- mg/L 1 SM 2540E 8.75 pH Units 1 SM 4500H+B 460000 mg/L 1000 SM 5220D mg/L mg/L mg/L mg/L 1 1 1 1 TX 1005 TX 1005 TX 1005 TX 1005 MDL 25 0.006 0.0016 0.0022 0.0012 0.0068, 0.008 0.0017 0.0068 0.15 0.0021 6900 T104704207-13-8 Date of Draft Report: 1/17/2014 Date Received: 1/10/2014 TALEM Project No: 140110002 Waste Profile CollectDate/Time: 1/10/2014 9:20 Test QC Ref PQL A/I Date/Time Number 20 0.050 0.0025 0.010 0.010 0.050 0.050 0.010 0.050 0 20 25 jvh 1/15/2014 QC-140115025 0.020 50 4.0 bsw /15/2014 3:00:00 PAQC-140116001 25000 hrt 1/14/2014 QC-140114023 5.0 5.0 5.0 5.0 Test results contained within•this data package:meet the.requirements of the National Laboratory Accreditation Conference (NELAC) unless otherwlseindicated. Page 1 of 1 * - An asterisk (*) denotes tests/parameters which are not covered by the scope cif our NELAC accreditation. h. What is the current and or past method of disposal for this waste stream? Material has been coming to Village Creek for past 7 months i. Do you use Quaternary Ammonium Sanitizer Solutions at your facility? Yes No Not Sure j. Please list all the sanitizers used at the facility and provide MSDS for each, if it has not been provided as a part of Pretreatment Permit Application: _None 2. Quantity of Waste (This must be completed for each type of waste) a. hstimated Annual Volume: 1,500,000 gallons /year b hstimated volume in a weekly basis: 30,000 gallons/ week 3. Shipping Information (This must be completed for each type of waste) a. Method of shipment (circle applicable method): • Contract Hauler • City of Fort Worth Permitted Hauler Trucks • Facilities own trucks b Estimated volume per shipment: _5000 gallons c. Shipping frequency: (Circle) Daily Weekly Bi-weekly Other: 4. Generator Certification By signing this profile sheet, the generator (or the generator's authorized representative) certifies that all information submitted on this profile and attached documents are true and correct. In addition, the generator certifies that 1) The waste being delivered is not hazardous waste or material as defined by any and all local, state and federal laws, with the exception for waste with a low pH due to the presence of organic acids; 2) this profile sheet and its attachments contain true and accurate descriptions of the waste material; 3) All relevant information regarding known or suspected hazards have been disclosed; 4) that the generator will immediately notify the CITY of any material change in the composition of the waste which could result in the waste otherwise being characterized as hazardous; 5) that the generator shall not deliver or arrange for delivery, waste material to the CITY that does not conform to the description in the profile; and 6) that the generator shall INDEMNIFY AND HOLD THE CITY OF FORT WORTH ". ESS FROM ANY AND ALL DAMAGES EXPENSES, FINES OR PENALTIES RESULTING FROM ANY WASTE DELIVERED TO THE VCWRF Signature Print Name gnd Title / / /'M Date