Laserfiche WebLink
04/12/96 10:41 FAX 209 46f '''067 FORWARD INC. 11002/003 <br /> FORWARD W — PROFILE# 8552 <br /> ED APPROVAL# <br /> WASTE PROFILE FORM <br /> PLEASE DETACH AND RETURN r0:FORWARD INC.,P.O.BOX 6336, STOCKTON, CA 95206 FAX(209)466-1067 PHONE(209)466.4482 <br /> A.GENERAL INFORMATION <br /> Generator Name: .-V . (`(l2CatTt Billing Name: <br /> Mailing Address: BillinaAl <br /> City: Cle State: re: 7 P: CityContact . T de: Contat Tide: <br /> Telephone No.: axx No_ Telephone No.: <br /> Consultant Name: �l, 1 fitit(L G/�"CWIA c y,ueSTransportec 17 6 LTl4 �rtT-R1 Al ts2 <br /> Mailing Address —(`{ 13 W P L M,2 S3— Mailing Address: f•0. 4J be , � <br /> City: _. �'6� C.Y� rJ State: zip:�S'2- � City: ST-2, State:, Zip: 4S P- <br /> -zip: <br /> fit., N A V 6L-(LO Tide: �Swr tw+T— Contact: s �.v Avm WL jcA'itle: nt t 44 TCF/ <br /> Telephone No.:tea`5 1 S4C �O . Telephoneo.: r Fax No.;(2ft) !z 5%-0651 <br /> B.WASTE STREAM IDENTIFICATION <br /> Site Address: g'1 1(. '5 • S rj' <br /> Description of waste: ?1ZCS54XED WkSACj? /T RtPP( 121N5L�s �L.tD WMCc 4-TW M+S-Mfk0" 1 LAS—) ut tC <br /> Process generating waste: %Z1 a exti s.0 t C t02LQ ! 0 pPQM ICA�t a C t t�AS trtt ILc ca s s t wt G <br /> C.WAsm STREAM DFsm noN <br /> 1. Waste Type: V'Soil a Sludge ❑Ash ❑Treated Wood O Debris O Asbestos O Othu <br /> 2. Anticipated Volume: O Tons M_Cubic Yards f 5--7c> 0 Drums ❑Other <br /> 3. Method of Shipment: ❑Bulk solid O Containerized (Type): `W '`(MLD •v 1147 N 6K.- rC4 h t C- %r"i <br /> 4. Shipping Frequency: ❑Moonily O Yearly 11COne Timc 3 Other <br /> S. Asbestos Containment Method: 0 Bags O Canons O Drums O Wrapped ❑Other Q DOT Proper Shipping Nam,: <br /> 7. Physical State: J"Olid 0 Slurry ❑Paste D Powder O Other 8. Percent Mol's A Q d! <br /> 9. Odor: D Soong 0 Mild 14 None 10. Color of Marial: MA tom.a-cssA wt,a 11. pH: <br /> ter <br /> 12. Soil Type: 9a Sand Silt Clay 13. Free Standing Liquids: O Yes �010 <br /> D. ANALYTICAL SUMMARY(ATTACH ALL CERTimm LAB RFSULTS AND CHAIN OF CUSTODY DOCUMENTATION) <br /> POther- <br /> L PETROLEUM AVG HIGH Units BTEX(EPA 8020) AVG HIGH Units <br /> OCARBONS (PPM (PPM <br /> (Specify Method-e. .SO1S) / b) I b) <br /> ine Benzene <br /> Diesel Tolugne <br /> r 1 or T G Ibe <br /> len <br /> VOLATILE ORGANICSSEMI-VOLATILE <br /> (Specify Method-e.g.8260) ORGANICS(EPA 8270) <br /> List Detected Analytes: List Detected Analytes: <br /> Other Anal 'cal Methods: Other Analytical Methods: <br />