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62r2G/2099 15:35 916-973-1172 DALTON ENGINEEP,ING PAGt e4 <br /> i <br /> U <br /> /oi f Page i 01`2 <br /> ALLIED WASTE <br /> GENERA'T'OR WAS'T'E PROFILE SHEET <br /> ,/ Waste Profile # <br /> Requested Disposal Facility: -0—Xa)A--0 <br /> an Allied Waste Company <br /> L Generator Fnformation Aate: <br /> Generator Name: p �� <br /> Generator Site Address: <br /> City: M&egaa I County: u, State: zip: -3,3p <br /> Generator State ID Number: Cf Loo / SIC Code Number: <br /> Generator Mailing Address (if different): <br /> City: I County: State: Zip: <br /> Generator Contact Name: •t 11 <br /> Phone Number:(,)pq� -$.2 -p,f,, 7C) Fax Number: <br /> YI. 'Trans orte nforaaation' - —� <br /> Transporter Name: <br /> Transporter Address: G'w- <br /> city <br /> ,oCity o. ,,,_V State: ' Zi �y <br /> Transporter Contact Name: <br /> Phone Number: l / - 6 g6 y Fax Number: /6 3S/'f4-L7,3 <br /> State Transportation umber; 3 0 j p <br /> M. Waste Stream Information <br /> Name of Waste: <br /> Process Generating Waste: Oe'wze /it/ ai�i- /9N��rirwuBe. <br /> Type of Waste: LJ INDUSTRIAL PROCESS WASTE or K POLLUTION CONTROL WASTE <br /> Physical State: XSOLJD SEMI-SOLID POWDER LILI UID IOTHER: <br /> Method of Sh' ment: BULK El DRUM Lj BAGGED OTHER: <br /> Estimated Annual Volume: CUBIC YARDS: 60 ❑ TONS: OTHER: <br /> Frequency: X ONE TIME Lj DAILY Lj WEEKLY Lj MONTHLY OTHER: <br /> Special Handling Instructions: <br /> IV. Representative Sample Certification ❑ NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory analysis, YES oz ❑NO <br /> collected in accordance with U.S.EPA 40 CFR 261.20 c dclines orequivalent rules? 1F' <br /> Sample Date: &/& O O 7 TLyee of Sample: COMPOSITE SAMPLE GRAB SAMPLE <br /> Sam let's Em Ioyex: v <br /> Sampler's Name (printed): a10wg Signature: <br /> Aided Waste,August 2000 <br />