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A "WA <br /> DD <br /> -� JOB# _ L i <br /> APPROVAL# <br /> ` WASTE PR®FEL E FORM <br /> PLEASE DETACH AND RETURN TO:FORWARD INC., P.O.Box 6336, STOCKTON, CA 95207 FAx(209)466-1067 PHONE(209)466-4482 <br /> u A.GENERAL INFORMATION <br /> Generator Name: (�V►i�JP r��—{/Cuvt�� loop. Billing Name: <br /> Mailing Address: 217 n(pr J14 A-A Billing Address: 21 <br /> City: i�f"l ep (L State:VAZip: 16105 City: G_st le State: T Zip: 610 <br /> Representative: 174-kyi6 U,(5� Title: awti rol(tr Representative: R�rl�.. '& <br /> :c (,25�rrq__ Title: Gv% ((t,-- <br /> Telephone No.: 412-brj$-6631 Fax No.: 412-658-06 Af- Telephone No.: 4-12-4-58- 663t Fax Na.: 4(21- 652,-S646 <br /> u <br /> Consultant Name: Q CeSS 1tV i ro i t wte Kl A t Transporter: 5iE S C O <br /> Mailing Address: I lN. EVtl h 50 i ke 30.5- Mailing Address: 2-1 '5. <br /> u City: 150V\ J&V State: C,,k Zip: `j¢OQj( City: State: Zip: 5 3 t <br /> Representative: a,� Title: 'Rre sr clew- Representative: a v.; +"h Tit ' �C5, , <br /> Telephone No.: X406- F4- No.: 4OR=7-f j:j '57 Telephone No.: 2cl- 52-¢- 1653Fax No.: ZDj-524-0503 <br /> u B.WASTE STREAM IDENTIFICATION c ` /� p <br /> Site Address: 9 rjD I w�u 5ir,a3 Ir.\,,Lc�+OC �D� �1.A <br /> Description of waste: sc,;I <br /> Process generating waste: jz&ec.No'�w'\ <br /> C.WASTE STREAM DESCRIPTION <br /> u 1. Waste Type: [Soil Q Sludge ❑Ash ❑Treated Wood ❑Debris ❑Asbestos ]Other <br /> 2. Anticipated Volume: Tons 40-50 Cubic Yards #of Drums Other <br /> 3. Method of Shipment: Bulk solid ❑Containerized (Type); 4. DOT Proper Shipping Name: 13/A <br /> u 5. Shipping Frequency: p Monthly ]Yearly bone Time ❑Other <br /> 6. Asbestos Containment Method: ❑Bags ❑Cartons ❑Drums ❑Wrapped ❑Other N JA <br /> 7. Physical State: [Solid El Slurry ❑Paste 1]Powder ❑Other 8. Percent Moisture: <br /> u 9. Odor: ❑Strong ❑Mild lj�rNone 10. Color of Material: rowh 11. pH: --r7 <br /> 12. Soil Type: % - p` Sand 0` o Silt 80- 0' Clay 13. Free Standing Liquids: ❑Yes &'No <br /> u D. ANALYTICAL 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 /> u <br /> (Specify Method a .8015) / b) <br /> Gasoline Benzene <br /> Diesel Toluene <br /> L Motor Oil or TOG Ethvlbenzene <br /> Other: Xylenes <br /> VOLATILE ORGANICS ` ' SEMI VOLATILE ., <br /> (Specify Method e:g.8260) GFA e2ko/ Ei--A SZAYO ORGANICS(EPA 8270) <br /> List Detected Analytes 0260 ozbo List Detected Analytes: <br /> 140 &4 11c4= <br /> �ako�c �tC . Z 25 <br /> l W 3.3 .3 <br /> I -e wL 5.4- 23.1 <br /> uV,41 v 2 4-.o 13. 4- <br /> Other Anal tical Methods: <br /> ic �r NO'S One. tialF (0.5) `rl t_ rt�or-t,islq (��`C use� -b calculate ��Me, <br />