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FROM OWN) JUL 19 2010 10 :13 `ST. 10: 12/No. 6661196473 P 1 <br /> REPUBLIC sPECIAL WAST11 PROFILE Page 1 ut2 <br /> SERVICES <br /> 1 <br /> Wase Pffime f <br /> Requested Disposal Facility: <br /> sow"We Rn Infaoe.emaided piftft u,l FAWf+PWAMefy+ddwl1Wa n wmpded. <br /> 1. tianer■tor Information Sales Rep f. <br /> Generator Name' <br /> Generator Ste Address: tl <br /> Ck : �C /f Conn . S State:California ZI La <br /> State ID/Reg Na: Stolle Approvefflalsts Coda: — v eppilcalfle) NAIL # <br /> Generator Mailing Andreas tlf dlftererit <br /> CI Coup State,Callfomia ZI <br /> Generator Contact Name:, EMIJ: <br /> Phone Number: q t,( Fax Number: <br /> iia. ImpWartarinfannsiflaiji <br /> Transporter Name: Contact Name: <br /> Trans er Addrase:: <br /> C : County, State: Zip. <br /> Phone Number: Fax Number State Transportation Number; <br /> Ilb. dilllag Informstles <br /> Bill To: A Contact Name: <br /> Bililrl Address: RU• • A K Ercall: rn�, .� <br /> Cl#y; f j stare: Zi : Phone, OAAA82-1 0 <br /> It'll.. Wi ate Strom IMarnra410n <br /> Name of Waste: . r <br /> Process Generating Waste: <br /> Physical State: UQSOLID SEMI-SOLED©POWDER QLIQUID <br /> Method of Shipment: (MBULK [:]DRUM SAGGEDD OTHER: <br /> Estimated Annual llbltime:. S -Select Volume Type- <br /> Frequency. ONE TIME MANNUAL <br /> [PlsPDSW_ConflldefaWn:W LANDFILL 0SQL101FIgAMN ❑ RIOREMEDIATION <br /> Ili. RePresuntat[ve Sample Gertlfleation ONO SAMPLE TAKEN <br /> Is the representative sample coleded to prepare this profile and laboratM <br /> analysts,colleotMd In aeoordance with U.S,EPA 46 CFR 261.24(c)guidelines or YES or ONO <br /> equivalent rut es? <br /> Sam le Date: -7//.=TVDG of Sample:Q COMPOSITE SAMPLE 0 GRAB SAMPLE <br /> Sample ID Numbers:. -� _ <br /> REv <br /> 0 Repub9t gervkes,May 409 <br />