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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: 77 C Landfill: r---o tv a r' <br /> Contact: Generator: 4 F <br /> Phone#: 80 n _2 /4 3 Sales Person: S' <br /> Quantity: C y r- Site: a n <br /> Reviewed By: ;fr, Address: <br /> Waste Profile Form ❑ Accept Job# <br /> Chain of Custody ❑ Accept Approval#: <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX 0 Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> 0 Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf ❑ Accept <br /> BTEX ❑ Accept BTEX 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> Waste Oil Contamination 0 Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals 0 Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG ❑ Accept SVOCs 0 Accept <br /> VOCs ❑ Accept Paint Filter ❑ Accept <br /> SVOCs ❑ Accept TPH ❑ Accept <br /> TTLC CAM 5 Metals ❑ Acce t Reactivity, pH ❑ Accept <br /> PCBs ❑ Accept <br /> ❑ Other 0 Treated Wood <br /> r , S <br /> ORGANICS TTLC/TCLP PPM Metals TTL /STLC PPM <br /> TPH Gas Antimony / N - Mercury 1 < <br /> TPH Diesel Arsenic i I Z G /fQ3 7Molybdenum AIJAP <br /> TPH Motor Oil G n Barium Nickel 3 ,iqh <br /> Other: Beryllium </ Selenium �tI( Nig <br /> Benzene Cadmium h; Silver <br /> Total T.E.X. Chromium 7 X, Thallium <br /> 41) <br /> Total HVOC's Chromium 6 Vanadium e <br /> Total SemiVoc's Cobalt )-)- Zinc (3 <br /> Other: m Copper <br /> Lead 3 ;g <br /> NOTES: S rs t c - 3 �O <br /> DATE: <br /> I SAL: &LASS II ❑ SOIL <br /> PRE-LIEN YES NO Check w/Management <br /> - 7 L/- <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 />