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I <br /> ALLIED WASTE Page 1 of 2 <br /> GENERATOR WASTE PROFILE SHEET <br /> Waste Profile # <br /> Requested Disposal Facility Forward 3�?-42 <br /> an Allied Waste Company <br /> I. Generator Information Date A nl 16, 2003 <br /> Generator Name Mary Sanchez <br /> Generator Site Address 1876 Co un Club Blvd <br /> City Stockton I C unty San Joaquin State CA Zip 95203 <br /> Generator State ID Number SIC Code Number <br /> Generator Mailing Address if different 1633 W Walnut Street <br /> City Stockton County San Joaquin State CA Zip 95203 <br /> Generator Contact Name Dave Threlfall <br /> Phone Number 530 668-5399 Fax Number 530 662-0273 <br /> 11. Transporter InfoTmatno>rn <br /> Transporter Name Manley & Sons Trucking, Inc <br /> rans orter Address 8896 Elder Creek Rd <br /> C1 Sacramento Coun . Sacramento State CA Zi 95828 <br /> Trans orter Contact Name Mark Manley <br /> Phone Number 916 381-6864 Fax Number (916) 381-1573 <br /> State Trans ortation Number 2843 <br /> III. Waste Stream Information <br /> Name of Waste Gasoline contaminated soil <br /> Process Generating Waste- excavatio <br /> -Type of Waste INDUSTRIAL PROCESS WASTE or POLLUTION CONTROL WASTE <br /> Physical State SOLID SEMI-SOLID POWDER LIQUID OTHER <br /> Method of Sht ment BULK 0 DRUM L BAGGED OTHER <br /> Estimated Annual Volume ® CUBIC YARDS 7S'0 ❑ TONS <br /> OTHER <br /> Fre uencY. ® ONE TIME 0 DAILY WEEKLY MONTHI,Y OTHER <br /> Special Handling Instructions none <br /> IV. Representative Sample Certification <br /> Is the representative sample collected to prepare flus profile and laboratory analysis, <br /> collected in accordance with U S EPA 40 CFR 261 20(c)guidelines or equivalent rules'? ® YES Or ❑ NO <br /> ample Date March 7 WType of Sample <br /> ® COMosITE sAMLE ❑ GRAB SAMLE003 <br /> Sam n <br /> Geo-Engmeers <br /> Sampler's Name rinted Georize L Converse S1 afore <br /> 0 Altied waste tndustnes,August 2000 <br />