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®. Pagel of 2 <br /> A <br /> ALLIED WASTE <br /> GENERATOR WASTE PROFILE SHEET <br /> Waste Profile # <br /> Requested Disposal Facility: Forward Landfill <br /> an Allied Waste Company <br /> I. Generator Information FD-ate-. 10/3/06 <br /> Generator Name: Stockton Recycling <br /> Generator Site Address: 1533 Waterloo Rd <br /> City: Stockton I County: SJ State: CA Zip: <br /> Generator State ID Number: SIC Code Number: 5093 <br /> Generator Mailing Address (if different): <br /> City: I County: State: Zip: <br /> Generator Contact Name: Richard Powell <br /> Phone Number: 209/942-2267 Fax Number: 203/942-2289 <br /> H. Transporter Information <br /> Transporter Name: Stockton Recycling <br /> Transporter Address: 1533 Waterloo Rd. <br /> City: Stockton I County: SJ State: CA Zip: 95205 <br /> Transporter Contact Name: Richard Powell <br /> Phone Number: 209/942-2267 Fax Number: 209/942-2289 <br /> State Transportation Number: <br /> III. Waste Stream Information <br /> Name of Waste: Shredded Tires <br /> Process Generating Waste: shredding tires <br /> Type of Waste: ❑ INDUSTRIAL PROCESS WASTE or Z POLLUTION CONTROL WASTE <br /> Physical State: Z SOLID 0 SEMI-SOLID ❑ POWDER Ej LIQUID ❑ OTHER: <br /> Method of Shipment: Z BULK ❑ DRUM ❑ BAGGED ❑ OTHER: <br /> Estimated Annual Volume: Z CUBIC YARDS: 300 TONS: OTHER: <br /> Frequency: Z ONE TIME ❑ DAILY ❑ WEEKLY El MONTHLY 0 OTHER: <br /> Special Handling Instructions: <br /> IV. Representative Sample Certification Z NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory analysis, ❑ YES or ❑NO <br /> collected in accordance with U.S.EPA 40 CFR 261.20(c)guidelines orequivalent rules? <br /> Sample Date: I Type of Sample: ❑ COMPOSITE SAMPLE ❑ GRAB SAMPLE <br /> Sampler's Employer: <br /> Sampler's Name (printed): Signature: <br /> c <br /> v <br /> ©Allied Waste,August 2000 <br />