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02/26/2009 15:36 916-373-1172 WALTON ENGINEERING PAGE 04 <br /> Page 1 of 2 <br /> a4ueo wnM <br /> GENERATOR WASTE PROFILE SHEET <br /> ,� <br /> Requested Disposal Facility: Waste Profile #,Tol�LE%r4+t.J <br /> an Allied Waste Compmty <br /> I. Generator Information Date: <br /> Generator Name: j <br /> Generator Site Address: Ij c opo <br /> City: fo County: State: Zi <br /> Generator State ID Number: ( / SIC Code Number: <br /> Generator Mailing Address if different : <br /> City: County: State: zip: <br /> Generator Contact Name: — <br /> Phone Number: - Fax Number: p (, <br /> H. Trans orte nformation <br /> Transporter Name: <br /> Transporter Address: <br /> County: ,r,-V State: Zi ay <br /> Transporter Contact Name: /�f <br /> Phone Number: / / -6316/ Fax Number: /6 �S/-��3 <br /> State Transportation umber: 3 p�p <br /> ITL Waste Stream Information <br /> Name of Waste: <br /> Process Generating Waste: pcq✓E /N Drw /O or/�mwcis[. <br /> Type of Waste: D INDUSTRIAL PROCESS WASTE or POLLUTION CONTROL WASTE <br /> Pb site State: Z SOLID Lj SEMI-SOLID I I POWDER LIQUID Lj OTHER: <br /> Method of Shipment: BULK DRUM Lj BAGGED El OTHER: <br /> Estimated Annual Volume: CUBIC YARDS: TONS: OTHER: <br /> F uenc : X ONE TIME I I DAILY I I WEEKLY Lj MONTHLY Lj OTHER: <br /> Special Handling Instructions: <br /> IV. Representative Sample Certification NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory analysis, YES Or ❑NO <br /> collected in accordance with U.S.EPA 40 CFR 261.20 c guidelines or uivalent rules? <br /> Sample Date: I Type of Sample; [2d COMPOSITE SAMPLE GRAB SAMPLE <br /> Sampler s Employer: &6p <br /> Sampler's Name (printed): a K Signature: <br /> B Allied Waste,August 2000 <br />