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OQ/12/96 10:41 FAX 2094L_ ..067 FORWARD INC. 002/003 <br /> FORWA JT1W PROFILE# 85 52 <br /> ED APPROVAL# <br /> WASTE PROFILE FORM <br /> PLEASE DETACH AND RETURN r0:FORWARD INC.,P.O.BOX 6336, STOcxroN. CA 95206 FAx(209)466-1067 PHONE(209)466.4482 <br /> A.GENERAL INFORMATION /`cam,[/ f/ <br /> Generator Name -� . Cl12N;4 Billing Name: 1�`� / <br /> MaihngAddms;s: gi(linq Adel 101fl-a- <br /> City: ICK State: rA 7ip: City: <br /> Contact: . Tide: ' Contact. t Tide: <br /> Telephone No.: - -_Fax No= Telephone No.: ax No.: <br /> Consultant Name: M A7Q Rat-O4"CUikS hs,4A GSTmtuponer C) LT-A (2ZAPrA1 Ai�2 <br /> Mailing Addttss: w 'P P L S Mailiag Address: ?•d. d-' sc <br /> City: �� C,K---r t State til- Zp: SL-)7 City; C4�-T"-J State: T S <br /> Contact PtC- Al t1+U 614LO T de: C''j Swan T- Contact S-A.e- ---a ANN 1✓t J S <br /> Tele ne No.:a!4 S4 d Ei 7 !G Fax No.: _ tile: n(sP Pr TCN <br /> P� � � �.j1Z Telephone No.: d 2- Fax No.:/� ' S <br /> B.WASTE STREAM IDENMCATION DCA f ` C <br /> Site Address: Cj I C. S . CST/ SS a C4'T <br /> Description of waste: t'Zn57'Ai LK0 121N5EI 5OLLD W A4-rW MA-T6R4it ) Pl.A571-1Cs u <br /> Process generating waste: 1<1 a Ctce,u e C i6514•9-0 P-P ic^-V-t a:j ItIt c CC S S j 1j ::2 _ <br /> C.WASTE STREAM DFSCRIPTiON <br /> 1. Waste Type: f$_Soil 0 Sludge 0 Ash O Treated Wood O Debris O Asbestos 0 Other <br /> 2. Anticipated Volume: ❑Tons OLCubic Yards f 5-'Z<.> O Dmms ❑Omer <br /> 3. Method of Shipment: 0 Bulk solid O Containerized (Type):_`-' `l MLO •�T'At �'6�'L �C;1 A r e Y,Trrn i <br /> 4. Shipping Frequency: 0 Monthly O Yearly XOne Time 0 Other <br /> S. Asbestos Containment Method: O Bags O Carrons U Dnuns O Wrapped ❑Other 6. DOT Proper Shipping Name <br /> 7• Physical State: WSolid 7 Slurry 0 Paste 0 Powder D Other 8 Percent Mois <br /> 9. Odor: 0 Song 0 Mild R1 None 10. Color of Material: 1 ti- t cSx i tt, 11. pH: I`J <br /> 12. Soil Type: % Sand Silt Clay 13. Free Standing Liquids: 0 Yes )tNo <br /> D. ANALYTICAL SUMMARY(ATTACH ALL CERTmm LAB RESULTS AND CHALY OF CUSTODY DOCUMENCA710N) <br /> TOTAL PETROLEUM AVG HIGH Units BTEX(EPA 8020) AVG HIGH Units <br /> HYDROCARBONS (PPM (PPM <br /> (S ecifv Method-ea.801 / b) / b) <br /> Gasoline Benzene <br /> Diesel Toluene <br /> Motor Oil or TOG IFthylben=e <br /> Other- -XvIenes <br /> VOLATILE ORGANICS SEMI-VOLATII E <br /> (Specify Method-e.g.8260) ORGANICS(EPA 8270) <br /> List Detected Analytes: List Detected Analytes: <br /> Other Analvbcsl Methods: Other Analytical Methods: <br /> i <br /> � i I <br />