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STATEWIDE ENVIRONMENTAL SERVICES -.7-M. <br />200 PINE AVENUE, SUITE 514\� <br />LONG BEACH, CA 90802-30 <br />PHONE: (31H1 437-2242; F 10) 437-4562 <br />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 PROFILI <br />ACCEPTANCE # <br />SALES PERSON <br />2. GENERATOR INFORMATION <br />Name • RAYMOND AGR+etltTb1ME L f1� TYC' f1� <br />Addr: 2245 W. CHARTER WAY <br />City: STOCKTON, CA 95206 <br />Contact: MARK LAKEMAN/WILBUR RAYMOND <br />Phone: (209) 547-9000 <br />EPA #: iAi.t)OIh�!ll'�Ln <br />BOE #: <br />Name of Waste: WASTE PESTICIDES WITH ENDOSULFAN <br />Process Generating Waste: SITE CLEAN UP <br />US EPA Haz Waste Codes:(`;P1 , State Haz Waste Codes: 232 , <br />DOT Proper Shipping Name: Rd, WASTE PESTICIDES, SOLID, TOXIC, N.O.S., (ENDOLSULFAN) <br />Tech Name(s) Additional Description: RQ(Ibs) 1 <br />DOT Hazard Class: 6.1 DOT Id#: UN2588 PG #: II ERG #: 55 <br />Marine Pollutants? ✓ Yes; _No; Name: cn ,_7u in ) <br />Is this an EH waste? _Yes: XX No; Name: <br />Is this waste for... _Incineration Only; _Recycle Only; _Landfill Only. <br />Qty/Drums 1 Drum Size:_85; X 55;_30;_20;_15;_10;_5; _CU YD/BX/GALS <br />Is this a Lab Pack XX 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 Pyrophorlc <br />Yes No <br />X OSHA Carcinogens; Name:\l� <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, FID27, F028 <br />X Newly Listed/Identified <br />X FO39 Constituents Present <br />RANGE <br />Min. % Max % <br />100 <br />