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• PROFILE NO. <br /> WEST CONTRA COSTA SANITARY LANDFILL •�$ '��`� <br /> %VASTE t)ISPQSAL REQUESTIINFORMA110H FORM <br /> FAJU NAMFIDDRE <br /> . GE3ERATN Y S: <br /> Shell Service Station <br /> 6131 Pacific Ave" Stockton. cA <br /> 2 CONSULYaNT Q1 any) Aegf s• nvfrdnmentai Consultants <br /> Name: <br /> Brian Garber Telephone: C 916 }964-2110 , <br /> WASTE NAME: Low level Petroleum Contaminated soil <br /> 3. _ <br /> 12 Ton D�gRy PER100- one-Time <br /> a- . ANTICIPATED VOLUME: (par day, week, onodtme onlV) <br /> g, TFLkNSPORTA-noN FIRM: Steve' s Trucking <br /> TRANSPORT TRUCK: 10 CY 91 Serr"nd Double bottoms <br /> g, l'YPE OF .. <br /> Single bottom <Y Drap box `' indriiduai Containers <br /> a <br /> M t <br /> i7. Myo <br /> fl of PAYMENT: `Check Cash � Charge Purchase Oder <br /> Charge A PQ mint havee prior i 1 0 x 1 SLPurcriase Accounting <br /> No.�.. �ment roval) <br /> Charge Account Nameh <br /> g, Description of Process and Circumstances Producing Waste: <br /> Tank Closure, Dr%,11 Cuttings <br /> For WCCSL Use on1V <br /> F_O�M' <br /> ACGErP'r: <br /> P444LI 91 C:omplote� Acttharixad Sys <br /> Car++vatlb = uativ. <br /> Corr�pal�bsa "i' <br /> • AArE9 ANDf,EES: <br /> pptcnt+ally E„cornpai+ble �:�� r ai -�a1 Rste• ' <br /> ND: Yo:" Now Gounty/Su►to Fees <br /> Amewca br othot AMes!`aes. _. ► - --- <br /> sato: <br /> RC+r NS/J <br /> N\wastc rev 1 Of 4 <br />