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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: , <br /> �(��' Landfill: _�._1.,s...v, <br /> Contacts , -�' Generator: <br /> Phone#: i 00 g2 <br /> Sales Person: <br /> Quantity: ® Site: <br /> Reviewed By: Address: 1[-)-7/ jf` rtl 4' <br /> Waste Profile FormA ept Job# a <br /> 101) <br /> Chain of Custody 2,Accept Approval#: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX 0 Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> ❑ Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf ❑ Accept <br /> BTEX ❑ Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals 0 Accept <br /> Waste Oil Contamination ❑ Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals 0 Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG ❑ Accept SVOCs ❑ Accept <br /> VOCs ❑ Acce t Paint Filter 0 Accept <br /> AdWk SVOCs 0 Accept TPH ❑ Accept <br /> TTLC CAM 5 Metals 0 Accept Reactivity, pH ❑ Accept <br /> PCBs 0 Accept <br /> Other ,^14 ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas Antimony Mercury <br /> TPH Diesel _3 Arsenic Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: Beryllium Selenium <br /> Benzene A Y-) Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc <br /> Other: Copper <br /> Lead <br /> NOTES: <br /> cf::�2 t DATE: <br /> DISPOSALCLASS II <br /> PRE-LIEN YES ,N Check7wT VaFogement <br /> C3oq-© <br /> 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 />