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Jul 24 06 01 : 13p Ponder Enviro Service Inc 707-748-7776 p. 2 <br /> Sem <br /> aport Environmental - Accel re Procedure -Wastewater Character12 n Form Page 1 'of 2 <br /> Seaport QC ScaP,<< <br /> FiC�/.JCj <br /> Cit-y.CA'-1.1 Jr3 c•5- 3,:.102•=Fhon; q <br /> Enuironmental LpalclhCACXXT" r2 _,3aa_=.tu21ex <br /> Non-Hazardous Waste Water Characterization Form <br /> Address of Responsible Party I Site Address (if di event) <br /> Name: ►o L►.,��r6 i,r�,^e nl / Z <br /> Name: Q <br /> Authorized Rep:zkLr+� 0n � Contact_ Z/Ogr7 rr I / <br /> / S� <br /> Street: a �� L---,S7 Street: A0 � LIZL <br /> - <br /> City: State City: State: <br /> Phone: `707 - 75o4V —7-7-7 S Phone: 049 qq� S_;�v 4, �-- <br /> Activity or Process Producing Wastewater (check all that apply): <br /> Monitoring well sampling Excavation and Dewatering <br /> Monitoring well development/auger Pump test <br /> rinsate <br /> Other(describe): L 'r <br /> <_ <br /> Suspected Source of Contaminants: <br /> /" <br /> Does (or did)the site contain one or more underground storage tanks (UST's) for fuel? Yes_ No V <br /> Is a UST the suspected source of contamination? Yes_ No <br /> Are you aware of any other possible sources or causes of waste water contamination at Yes_ No_ <br /> the site? If Yes, please describe: <br /> Wastewater Characterization: <br /> Please provide copies of the results of any analytical work carried out on the wastewater. <br /> Is the pH less than 2 or greater than 12.5? Yes_ No <br /> Is the flashpoint less than 140 F (60 C)? Yes_ NoZ/ <br /> Is there any reason to suspect the presence of reactive cyanides or sulfides? Yes �✓ <br /> Is there any reason to suspect that the waste water would prove toxic in a fish Yes ✓No_ <br /> bio-assay test? <br /> Is there separate-phase liquid present in the waste water? Yes_/No— <br /> http://www.seaportenvironrnental.corrL/wastewater-fomi.btm <br /> 7/24/2006 <br />