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PACIFIC REGIONAL <br /> AN ALLIED WASTE COMPANT <br /> Client: C Landfill: W-3 r— <br /> Contact: Generator: o'Ce1 <br /> Phone#: 3 P Sales Person: 9 <br /> Quantity: f Site: <br /> Reviewed By: Address: To c <br /> Waste Profile Form ?Accept Job# <br /> Chain of Custody ff-Accept Approval#: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g 0 Accept TTLC CAM 17 Metals 0 Accept <br /> BTEX 0 Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> ❑ DieselNirgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf ❑ Accept <br /> BTEX ❑ Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> 0 Waste Oil Contamination 0 Sludge . <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG ❑ Accept SVOCs ❑ Accept <br /> VOCs ❑ Accept Paint Filter 0 Accept <br /> SVOCs ❑ Accept TPH 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept Reactivity, pH 0 Accept <br /> PCBs 0 Acce t <br /> ther ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas 00 Antimony Mercury <br /> TPH Diesel ap Arsenic Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: Beryllium Selenium <br /> Benzene No Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc <br /> Other: Co er <br /> Lead <br /> NOTES: <br /> _57G*i DATE: <br /> DISPOSAL: LASS II SOI <br /> PRE-LIEN YES NO Check w/Management <br /> 1145 WEST CHARTER WAY, POST OFFICE BOX 6336 <br /> STOCKTON, CA 95206 <br /> 800.204.4242/FAX 209.466.1067 <br /> www.disposal,com <br />