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STATEWIDE ENVIRONMENTAL SERVICES, INC. <br />200 PINE AVENUE, SUITE 514 <br />LONG BEACH, CA 90802-3040 X212 <br />PHONE: (310) 437-2242; FAX (310) 437-4562 <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 />WASTE IDENTIFICATION <br />Name otMaste: SOIL WITH METALS <br />Process Generating Waste: SITE CLEAN UP <br />WASTE DATA PROFILE <br />ACCEPTANCE # QW44 <br />SALES PERSON <br />2. GENERATOR INFORMATION <br />Name: RAYMONDF1 <br />G,� , � TR P ✓)+ <br />Addr: 2245 W. CHARTER WAY <br />City: STOCKTON, CA 95206 <br />Contact: MARK LAKEMAN/WILBUR RAYMOND <br />Phone: (209) 547-9000 <br />EPA #: <br />BOE #: <br />US EPA Haz Waste Codes: <br />D006, D007, D008 <br />State Haz Waste <br />Codes: 352 <br />DOT Proper Shipping Name: RQ, HAZARDOUS WASTE <br />SOLID, N.O.S., (LEAD, CHROMIUM) <br />Tech Name(s) Additional <br />Description: <br />RQ(Ibs) 1 <br />DOT Hazard Class: 9 <br />DOT Id#: NA3077 PG #: III <br />ERG #: 31 <br />Marine Pollutants? _Yes; <br />XX No; Name: <br />Is this an EH waste? <br />XX No; Name: <br />Is this waste for... <br />_Yes: <br />_incineration Only; <br />_Recycle Only; <br />XX Landfill Only. <br />Qty/Drums 1 Drum <br />Slze:_85; X 55;_30;_20;_15;_10;_5;_CU <br />YD/BX/GALS <br />Is this a Lab Pack XX <br />No; _Yes; Inventory Sheet Attached. Number of Lab Pack Drum(s)- <br />4. REGULATORY INFORMATION <br />Indicate if this waste has any of thes types: <br />N/A RCRA Reactive N/A Oxidizer N/A Shock Sensitive N/A Infectious <br />N/A Water Reactive N/A Etiological N/A Explosive N/A Pyrophoric <br />Yes No <br />X OSHA Carcinogens; Name: <br />X Regulated or licensed radioactive waste <br />X Regulated medical waste <br />X Asbestos <br />_ X PCB's <br />X Dioxin Waste F020, F021, F022, F023, F026, F027,I <br />X Newly Listed/identified <br />XF039 Constituents Present <br />0-_ _ <br />6-9 <br />RANGE <br />Min. % Max % <br />