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STATEWIDE ENVIRONNUiTAL SERV10E5YINC. <br />200 PINE AVENUE, SUITE 514 �Q <br />LONG BEACH, CA 90802-3040 <br />PHONE: (310) 437-2242; FAX (310) 437-4562��\O <br />1. BILLING INFORMATION <br />Name: VALLEY ENVIRONMENTAL SOLUTIONS <br />Addr: P.O. BOX 48 <br />City: STOCKTON, CA 95201 - <br />Contact: MARK LAKEMAN <br />Phone: (209) 547-9000 <br />3_ WASTE IDENTIFICATION <br />IM6TE DATA PR��O''FI'LE <br />ACCEPTANCE k2u, Lae - <br />SALES PERSON <br />2. GENERATOR INFORMATION <br />Name: RAYMOND .AGA4-CUL-Enke mpnA <br />Addr: 2245 W. CHARTER WAY <br />Clty: STOCKTON CA 95206 <br />Contact: MARK LAKEMAN/WILBUR RAYMOND <br />Phone: (209) 547-9000 �1 <br />EPA #: <br />BIDE #: <br />Name of Waste: LAB PACK ITEMS 1 <br />Alen <br />r)t u r <br />Process Generating Waste: SITE <br />CLEAN <br />UP <br />US EPA Haz Waste Codes: VARIOUS <br />State Haz Waste Codes: - <br />DOT Proper Shipping Name: <br />Tech Name(s) Additional Description: <br />RO(I ) <br />DOT Hazard Class: <br />DOT <br />Id#: <br />PG #: ER #e <br />Marine Pollutants? _Yes; _No; <br />Name: <br />Is this an EH waste? _Yes: <br />_No;. <br />Name: <br />Is this waste for... _Incineration Only; Recycle Only;/_Landfill Only. <br />Qty/Drums Drum Size:_85; _55;_30;_20;_15;_10; 5; _CU YD/BX/GALS <br />Is this a Lab Pack _No; XX Yes; Inventory Sheet Attached. umber of Lab Pack Drum(s) <br />4. REGULATORY INFORMATION <br />Indicate If this waste has any of thes types: <br />RCRA Reactive Oxidizer Shock Sensi <br />Water Reactive Etiological Explosive <br />Yes No <br />_OSHA Carcinogens; Name: <br />_Regulated or licensed radioactl <br />_Regulated medical waste <br />_ _Asbestos <br />_ _PCB's <br />_Dioxin Waste F020, F021, F 22, <br />_Newly Listed/Identified <br />F039 Constituents Pres t <br />5. CHEMICAL COMPOSITION <br />waste <br />6 TO 2_d-1-v,�, r� <br />Infectious <br />_Pyrophorlc a <br />F023, F026, F027, F028 <br />0 <br />RANGE <br />Min. % Max k <br />