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STATEWIDE ENVIRONMENTAL SERVICES, INC IX, <br />200 PINE AVENUE, SUITE 514 �\ <br />LONG BEACH, CA 90802-3040 <br />PHONE: 310) 437-2242• FAX (310)43 -4 <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 />WASTE DATA PR FI <br />ACCEPTANCE # LE <br />` A <br />SALES PERSON <br />2. GENERATOR INFORMATION <br />Name of Waste: LAB PACK ITEMS 1 .i 4o <br />Name • RAYMOND GR+GUI=44: r ! i `I I T <br />Addr: 2245 W. CHARTER WAY <br />City: STOCKTON, CA 95206 <br />Contact: MARK LAKEMAN/WILBUR RAYMOND <br />Phone: 209) 547-9000 <br />EPA #: N ,(lC I tlEi J l._ to <br />BOE #: <br />Process Generating Waste: SITE CLEAN UP 1) <br />US EPA Haz Waste Codes: VARIOUS State Haz <br />DOT Proper Shipping Name: <br />Tech Name(s) Additional Description: <br />DOT Hazard Class: DOT Id#: PG #: <br />Marine Pollutants? _Yes; _No; Name: <br />Is this an EH waste? _Yes: _No; Name: <br />Is this waste for... _Incineration Only; __ 5• 10• _ 5;_CU YD/BX/GALS <br />Is this a Lab Pack _No; XX Yes; Inventory Sheet, A ached. Number of Lab Pack Drum(s) T <br />RQ(lbs) <br />ERG #: <br />VARIOUS <br />4. REGULATORY INFORMATION <br />Indicate if this waste has any of thes types: <br />RCRA Reactive Oxidizer <br />Water Reactive Etiological <br />Yes No <br />_OSHA Carcinogens; Name:_ <br />_Regulated or licensed rad <br />_Regulated medical/F21, <br />_Asbestos <br />_ _PCB's <br />_Dioxin Waste F02IDNewly Listed/IdenConstituents <br />"�u A+ ;I' d <br />Sensitive Infectious Lim ���erUUFl1/ <br />osive _Pyrophoric JT <br />ive waste <br />F022, F023, F026, F027 <br />5. CHEMICAL COMPOSITION / RANGE <br />Min. % Max <br />