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STATEWIDE ENVIRONM NTAL SER CES, INC. <br />200 PINE AVENUE, SUITE 51 ���- <br />LONG BEACH, CA 90802— 0 <br />PHONE: 310) 437-2242• F 10 437-4562 <br />1. BILLING INFORMATION <br />Name: VALLEY ENVIRONMENTAL SOLUTIONS <br />Addr: P.0- BOX 48 <br />City: STOCKTON, CA 95201 <br />Contact: MARK LAKEMAN <br />Phone: (209) 547-9000 <br />3. WASTE IDENTIFICATION <br />WASTE DATA PROFI <br />— <br />ACCEPTANCE #' <br />SALES PERSON <br />2. GENERATOR INFORMATION <br />Name: RAYMOND "" '"Tv rrooiTv'RA6 -1 n <br />Addr: 2245 W. CHARTER WAY <br />City: STOCKTON, CA 95206 <br />Contact: MARK LAKEMAN/WILBUR RAYMOND <br />Phone: (209) 547-9000 <br />EPA #: i.A( .Gini ll�il_ 1310 ___ <br />BOE #: <br />Name of Waste: LAB PACK ITEMS S,,)Ac¢, r ff, <br />Process Generating Waste: SITE CLEAN UP u <br />V <br />US EPA Haz Waste Codes: <br />VARIOUS <br />State Haz Waste <br />Codes:_ <br />DOT Proper Shipping Name: <br />Tech Name(s) Additional <br />Description: <br />RQ(Ibs) <br />DOT Hazard Class: <br />DOT id#: <br />PG #: <br />ERG #: <br />Marine Pollutants? _Yes; <br />_No; Name: <br />Is this an EH waste? <br />_Yes: _No; Name: <br />Is this waste for... <br />_Incineration Only; <br />_Recycle Only; <br />_La <br />Qty/Drums Drum <br />Size: _85;_55;C <br />Is this a Lab Pack _No; <br />XX Yes; Inventory <br />Sheet Attached. Number oA <br />4. REGULATORY INFORMATION <br />Indicate if this waste has any of thes types: <br />RCRA Reactive Oxidizer Shack Sensitive <br />Water Reactive Etiological Explosive <br />Yes No <br />_OSHA Carcinogens; Name: <br />_Regulated or licensed radioactive was <br />_Regulated medical waste <br />_Asbestos <br />_PCB's <br />_Dioxin Waste F02O, F021, F022, 3, <br />_Newly Listed/Identified <br />F039 Constituents Present <br />d'fIII Only. <br />YD/BX/GALS <br />b Pack Drum(s)J_ <br />,� acticcL <br />nfect i ous <br />yrophorlc CXR <br />F026, F027, FO28 <br />5. CHEMICAL COMPOSITION / RANGE <br />Min. % Max <br />