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08/04/95 10:09 FAX 209 4e 067 FORWARD INC. 0004/005 <br /> FL"-J%RWA.1%1--1; <br /> PRoFWE# 6206 <br /> INCORPORATED APPROVAL# <br /> WASTE PROFELK FORM <br /> PLEASE DETACH AND RETURN TO:FORWARD INC.,P.O. Box 6336,SrocmN, CA 95206 Fax(209)466-1067 PHONE(209)466-4482 <br /> A.GENERAL INFOPMATION <br /> Generator Name: Y , L �, Billing Nems: "'` <br /> Mailing Address: 0 5 3(� t.J W(1 ��.i v� ;�". Billing Address: <br /> City: 6 V-0 C-br--n rJ State: ('J�.Zip:_ ,,, City: State: Zip: <br /> Contact: < _Title: . M %ft S"11 Contact: Title: <br /> Telephone No.: `t 6 1 3�3 Fax No.: E k6 7 --KYTelephone No.: Fax No.: <br /> Consultant Name:_ N A Transporter. �R�L 5 o,J �,���•2 e,�,ti.`gin i �_ <br /> Mailing Address: Mailing Address: - c c"� o <br /> City: State: Zip: City: d(o4mc-'✓> State:,_Zip: <br /> Contact Title: Contact: Ur/a(L& '�To c k�c� Title: <br /> Telephone No.: Fax No.: Telephone No.: ";-M-2 20--?-yF 9 Fax No.:S-10-•)3 5--3?1'g <br /> B.WASTE STREAM IDENTIFICATION <br /> Site Address: <br /> Description of waste: j nl So 2v 3;2 f S. <br /> Process generating waste: S c, ,ora A S Pc L(-, <br /> C.WASTE STREAM DESCRXMON <br /> 1. Waste Type Soil O Sludge ❑Ash O Treated Wood Q Debris 0 Asbestos 0 Other, <br /> 2. AnticipatedVolume: a Tons ACublc Yards '�L C rD l]Drums 0 Other <br /> 3. Method of Shipment: J3 Bulk solid ❑Containerized (Type): <br /> 4. Shipping Frequency: (3 Monthly 0 Yearly MOne Time ❑Other <br /> S. Asbestos Containment Method: 0 Bags 0 Cartons 0 Drums 0 wrapped 0 Other 6. DOT Roper Shipping Name: <br /> 7. Physical State: V Solid 0 Slurry O Paste a Powder ®Other 8. Percent Moisture: <br /> 9. Odor. Cl Strong 0 Mild t4 None 10. Color of Material:1� f L,6 2",1- 11. pH: <br /> 12. Soil Type: %A2-�vSand c'y�-0- Silt Z�--,2S Clay 13_ Free Standing Liquids: 0 Yes 0 No <br /> D. ANALYTICAL SUMMARY(ATTACH ALL CERTIFIED LAB RESULTS AND CHAM OF CUSTODY DOCUMENTATION) <br /> TOTAL JPETROLEUM :;. :. ;:'AVG' '.".: 'HIGH; [Jttifs .BTEX(EPA$020).: AVG HIG$ Units <br /> HYDROCARBONS.•.:.:,,i, Y:. (PPM (FTM <br /> (S •Method=i&"861 5).: Y b) I h) <br /> Q <br /> Diesel I duene <br /> Motor Oil or IQQ Eth l <br /> the • X_ylenla <br /> VOLATILE;ORGANICS,. :' SEMI-VOLATILE <br /> (Specify Meth =e,g:8260) ORGAPtICS•(EPA 8270) <br /> List Detected Analytes:.'•..• List Detected Analytes: <br /> Other Analytical Methods: Other Analytical Methods: <br /> � L� <br />