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WARD JOB# <br /> INC APPROVAL# <br /> WASTE PROFILE FORM <br /> PLEASE DETACH AND RETURN TO FORWARD INC, P O Box 6336, STOCKTON, CA 95207 FAx(209) 466-1067 PHONE(209)4664482 <br />' A. GENERAL INFORMATION <br /> Generator Name Sf GsLG- Ole- Billing Name <br /> Mailing Address _ p CT 40o7-3 _ Billing Address. S - S d <br />' City (fzA)C:/jX!2 State C-04 Zip 9g572- City State Zip <br /> Representative 1],,9,,J Title- Representative Title <br /> Telephone No 0054,7$'=� Fax No (96>G2f-_6 <br /> ZJZ,.- Telephone No Fax No <br /> Consultant Name Ea �L Transporter Artier F So.�s � � �G <br /> Mailing Address /dSD /!!5�Z4 'C.✓ ft O Mailing Address 'R'99(. <br />' <br /> City L z 4 9 State GAZip 95173? City S A--OG ¢M4,-AV7-D _ State (2#4- Zip qS$Z: <br /> N� _Representative V +"W Title xC zT .IrJ.t0zjX Representative /i.w et140iJel-V Title��✓,c/ <br /> Telephone No J/,J) Z-W/o Fax No (914) tG-72 3 6 Telephone No (!2 15/-1S7,y Fax No / 39/-)5= <br /> B. WASTE STREAM IDENTIFICATION <br /> Site Address ?%d v i G TRK.. <br /> Descnption of waste 'Sz)I L_ -- c_ c.AC-:r+ <br />' Process generating waste D - tl+JD S nl s►ArL Fr�%o�c.aF Ari 1 �"Tf'klJ1�- <br /> `�J�C1i°ti <br /> C. WAsTE STREAM DE.scRiFnoN <br /> Waste Type ®Soil p Sludge ❑Ash ❑Treated Wood ❑Debns Q Asbestos ❑Other <br /> p Anticipated Volume Tons e�, b Cubic Yards #of Drums Other <br /> 3 Method of Shipment a Bulk solid ❑Containenzed (Type), 4 DOT Proper Shipping Name <br /> t5 Shipping Frequency ❑Monthly 0 Yearly G One Time ❑Other <br /> 6. Asbestos Containment Method Q Bags Q Cartons ❑Drums ❑ Wrapped ❑Other <br /> 7 Physical State J§Solid ❑Slurry Q Paste 0 Powder ❑Other 8. Percent Moisture <br /> t9 Odor ❑Strong ■Mild p None 10 Color of Material 11. pH <br /> 12 Soil Type % 2 S Sand -'?a Silt Clay 13 Free Standing Liquids p Yes a No <br /> D ANALy-nCAL SUMMARY(ATTACH ALL CERTIFIED LAB RESULTS AND CHAIN OF CUSTODY DOCUMENTATION) <br />' TOTAL PETROLEUM AVG HIGH Units BTEX(EPA 8020) AVG HIGH Units <br /> HYDROCARBONS (PPM (PPM <br /> (Specify Method-e. 8015) I b) 1 b) <br /> Gasoline / U / Z0 o PPNLBenzene <O-® T w ►'� <br /> Diesel map cuu . D ?-4- <br /> -rXvielto7 13o a <br /> VOLATILE ORGANICS SEMI-VOLATILE <br /> (Specify Method-e.g.8260) ORGANICS(EPA 8270) <br />' List Detected Analytes: List Detected Anslytes: <br /> Other Anal tical Methods. Other Analytical Methods: <br />