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03/23/99 15:51 '0707 748 8297 ALL WASTE 191002/004 <br /> Seaport Environmental- Non-Hazardous Waste Water Characterization Form <br /> Address of Responsible Party Site Address (if different) <br /> Name: Name!—/ rv4dt <br /> Authorized <br /> Rep: AAL t'zfaiz,A Contact:�uE'4 <br /> street a Ff/�,�J(L�n �,r� Street: 3 L sj <br /> Phone: 4{,DO �O Q t!76k Phone: Y I(o-�r Vii' Yvon <br /> Fax: 707- 7`♦Ip -7 <br /> Far. <br /> Activity or Process Producing Wastewater (Check all that apply): <br /> Monitoring well sampling Excavation dewatering <br /> L. <br /> Monitoring well development/auger rinsate Pump test <br /> Other (describe) <br /> Suspected Source of Contaminants: <br /> Does (o, did) the site contain one or more underground <br /> storage _a,.ks(UST's) for fuel? Yes NoO <br /> Is a US-the suspected source of contamination' YesEl No[P-/ <br /> Are you aware of any other possible Sources or causes of <br /> waste water contamination at the site? YesC No <br /> If"Yes", please describe: <br /> Wastewater Cha:actarizatinn: <br /> Plea,e prvide copies of the resuits of any analytical work carred out on the wastewater. <br /> rs the pi{ less than 2 or greater than 12.5? Yes[] No !. <br /> Is the Gas,-,p-+nt less than 140 F (@D C)? Yeso M1o� <br /> Is there any reason to suspect the presence of reactive cyanides or sulfides? YesEl No� <br /> Is there any reason to suspect that the waste rater would prove toxic <br /> in a fish bio-assay test? YeSD No Err <br /> Is there separate-phase liquid present in the waste water? Yes t- .yc7 <br /> Can you detect any hydrocarbon odor from the wastewater? YesNor-1 <br /> Was the wastewater tested for hydrocarbons? Yes Noff�/ <br /> Is there any reason to suspect the presence of Chlorinated hydrocarbons <br /> such as trichloroethylene? YesLI No P/ <br /> !A/as tie wastewater tested for chlorinated hydrocarbons? Yeso NoE�J' <br /> Is there any reason to suspect the presence of heavy metals, such as lead? Yeses No(v� <br /> Was the wastewater tested for heavy metals? Yes No LL^`_T`_ / <br /> Page 1 <br />