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4, <br />KI <br />1.' <br />RETURN TO FORWARD INC. <br />ATTN: Environmental Compliance Officer <br />P.O. Box 6336 <br />Stockton, California 95206 <br />SECTION A. GEN ERATOR/TRANSPORTER INFORMATION <br />Waste Generator. Company Name: <br />Contact Person: Phone. <br />Generating Facility. Address: <br />City. State, _ <br />Transporter. Company Name: <br />Contact Person: Phone: <br />Consultant: Company Name: <br />Contact Person: Phone: <br />SECTION B: WASTE STREAM IDENTIFICATION <br />General description of waste. <br />Process generating waste: <br />Zip: <br />SECTION C: PHYSICAL CHARACTERISTICS <br />Color. Physical State: ❑ Solid ❑ Liquid ❑ Slurry ❑ Paste ❑ Powder Free Liquids: ❑ Yes ❑ No <br />pH: Odor. ❑ Strong ❑ Mild ❑ None <br />J <br />M <br />SECTION D: WASTE COMPOSITION (see SECTION E for asbestos) <br />(include range of concentrations for multiple samples) <br />Total Petroleum Hydrocarbons <br />Metals Total Soluble (Cal. WET) <br />as gasoline <br />Ppm <br />(ma/ka) (ma/1) <br />as diesel <br />ppm <br />Antimony <br />as motor oil <br />ppm <br />Arsenic <br />other. <br />ppm <br />Barium <br />Aromatic Hydrocarbons <br />Beryllium <br />Benzene <br />ppm <br />Cadmium <br />Toluene <br />ppm <br />Chrom. (total) <br />Xylenes (total) <br />ppm <br />Chrom. VI <br />Ethylbenzene <br />ppm <br />Cobalt <br />Copper <br />Other Components ( list): <br />Lead <br />ppm <br />Mercury <br />ppm <br />Manganese <br />ppm <br />Molybdenum <br />ppm <br />Nickel <br />ppm <br />Selenium <br />ppm <br />Silver <br />ppm <br />Strontium <br />ppm <br />Thallium <br />ppm <br />Vanadium <br />ppm <br />Zinc <br />ppm <br />Others (list): <br />ppm <br />ppm <br />(attach or submit additional sheets if necessary) <br />J <br />M <br />