Laserfiche WebLink
' WARD JOB <br /> APPROVAL# <br /> 6= WASTE PROFILE FORM <br /> Pmim DETACH AHD RETURN To.FoRm=1Hr-,P 4.Box 6336,SrocKmx, CA 95207 FAX(204)466-1067 PNoNE(209) 466-4482 <br /> A.GENERAL INFORMATION <br />' Generator Name: 0.1c_ C444AAA 1,/ Billing Name: /lw E <br /> Mailing Address: Po &OT S/oZ3 Billing Address: <br /> City- Ca u,,A&2 __State- Go4- Zip 95/SLvf City State: Zap: <br />' Representative Title:_ Representative Title- <br /> Telephone No. d)475--t Z JFax No.. (262 G7--Q7L Telephone No. Fax No. <br /> Consultant Name: 1VfrAee) gziillr �- Transporter <br /> Mailing Address: /4-10 eV L.wJ 0- D Mailing Address: R T7 <br /> City "49 State Gs4p 9517�? City- State. C•4- ZIP.-90Z2? <br />' Representative V N(,!-.e.�1.�1 Title: T A.J.4dx+k Representativ�i.w�Y Title. <br /> Telephone No y14)7$2-zrro Fax No. 9G)7V,-783a Telephone No..(,g/,&) 331-I-C73Fax No.:(ft- 3) 9I-l� 'L <br />' $. WASTE STREAM IDENYM ATION <br /> Site Address: 5I TI r- a /?-oA GIGTl C-14 <br /> Description of waste. d / t- <br />' Process generating waste: T <br /> C.WASTE STREAM DEsCRnmoN <br /> 1. Waste Type: a Soil Q Sludge Q Ash Q Treated Wood Q Debris Q Asbestos Q Other <br /> ?. Anticipated Volume: Tons _ '�O a _Cubic Yards #of Drums Other <br /> 3. Method of Shipment. &Bulk solid Q Containerized (Type); 4. DOT Proper Shipping Name <br /> S. Shipping Frequency Q Monthly Q Yearly 6 One Time Q Other <br /> 6. Asbestos Containment Method: Q Bags Q Cartons Q Drums Q Wrapped Q Other <br /> 7. Physical State Q Solid Q Slurry Q Paste Q Powder Q Other 8. Percent Moisture: <br /> 9 Odor. ■Strong Q Mild Q None 10. Color of Material: 11. pH <br /> 12. Sotl Type.% teo Sand `-'a Silt Clay 13. Free Standing Liquids p Yes Q No <br /> D. ANALYTicAL SummARY(ATTACH ALL CEI rm=LAS ftsu n AND CHAIN OF CUSTODY DocumorrA=rq) <br />' TOTAL PETROLEUM AVG HIGH Units BTEX(EPA 802% AVG HIGH Units <br /> HYDROCARBONS (PPM {PPM <br /> (S Method- 8015) / b} I b) <br />' r7 o M Motor Oil or TOG <br /> 5Z.3-0 3 0 o VOLATILE ORGANICS. SEMI-VOLATILE <br /> (Spedfy Method-er-8260) ORGANICS(EPA.8270) <br /> ILitt Deter.Analytesr v L"t Detected Analy tim <br /> Other Analytical Methods: Other Analytical Methods: <br />