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r OR !' ►1�1 Rj�TQ <br /> 1 RD PROFILE# 7 0 4 1 <br /> INCORPORATED APPROVAL;# <br /> WASTE PROFILE FORM <br /> PLEASE DETACH AND RETURN TO FORWARD INC, P D Box 6336, STOCRTON, CA 95206 FAX(209)466-7067 PHONE(209)466-4482 <br /> A. GENERAL INFORMAnoN <br /> Generator Name Billing Name <br /> Mailing Address `la o Billing Address COL,-3 Cr-,^14 C, (JO <br /> Cary Atare—(2-�,ziQ °. City " � State--C�zp' 4q ci!921's <br /> ContactTitle &,.r ft l lo1iy-Contact_ <br /> o`j Tide <br /> Telephone No � - 1 _31Fax No�Stio� 2� _a� Telephone No tia d 11 Fax No L26),D;74-1.4 <br /> �, <br /> Consultant Name P t Transporter unto c&r A !So n S -7 <br /> Mailing Gress V Marling Address 9A&99 Lir Cc.�k CZE SL <br /> City s Zip city State <br /> Contact Title Contact: ride <br /> TefephoneNo Fax No �b Telephone No ((;k(-)1201-(g `i_FaxNo �`11�} 3B,[-15 -3 <br /> B.WASTE STREAM IDENTmc.Anm <br /> Site Address _L <br /> Description of waste \ — <br /> Process generating waste <br /> C.WASTE STREAM DEsCRnrnON 1 <br /> 1. Waste Type >kSoil ❑Sludge Q Ash ❑Treated Wood ❑Deons 0 Asbestos ❑Other <br /> . 2. Anticipated Volume ❑Tons iXCubic Yards 0 Drums 0 Other <br /> 3. Method of Shipment. I Bulk solid 0 Contamenzed (Type} <br /> 4. Shipping Frequency O Monthly ❑Yesriy:P One Time ❑Other <br /> 5. Asbestos Containment Method Q Bags 0 Cartons a Drums ❑Wrapped Q Other 6. DOT Proper Shipping Name <br /> 7. Physical State ❑Solid ❑Slurry 0 Paste ❑Powder ❑Other 8. Percent Moisture- i 3 ° <br /> 9. Odor a Strong U Mild 21 None 10 Color of�fatenal_ �reiv.i+�.1 11. pH-slt�k"ul r1 ' <br /> 12. Soil Type % Uzo �5and _ Silty O__Clay 13. Free Standing Liquids ❑Yes �ilNo <br /> D. ANALYTICAL SUMMARY(ATTACH ALL CERTIFIED LAa RFs us AND CMUN OF C=oDY Docum:ENTAmoN) <br /> TOTAL PETROLEUM T !. AVG _ = HIGH _Units BTEX(EPA 8020) AVG HIGH _Units <br /> HYDROCARBONS' - _. u - - (PPM r (PPM <br /> ( Method- � 80 _ -- - - b) �'- - - - _ - _ - _ b) <br /> l Benzene I<o-aa I <4-m5 m <br /> Dtesei lue e I o ays ( ooS 1� M <br /> Motor or TOG Eitalb.-eat ne I<o cuS I ao5 10 N^ <br /> tbcr� XylenesI e au S I oo<- <br /> I tY• <br /> VOLATILE ORGANICS SLNU-VOLATILE <br /> (Specify Method-e.g_8260) ORGANICS(EPA 8270) <br /> List Detected Analytes: List Detected A mafvtes; <br /> I I I ! <br /> I I I I I <br /> I I I I I I I <br /> i <br /> Other -kti <br /> nafvcal Methods I I I Other -knalvttctl Methods- I I I I <br /> I 1 I I F I <br /> 1 { I I } I <br />