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WASTE PROFILE FORM <br />PLEASE DETACHAND RETURN TO: FORWARD INC., P.O. Bo.Y6336, SwcKmN, CA 95207 Fax (209) 466-1067 PHONE (209) 466-4482 <br />A. GENERAL INFORMATION <br />/// / V <br />Generator Name: Ir "d V d 1 - ,l �PY� Billing Name: ami U h SU f� sa <br />Mailing Address: 0 i.V 0 2 e ]/ e. Billing Address: <br />City: State: Zip: City: <br />State: Zip: <br />Representative.V/# Title: � c9�1C Representative: Title: <br />Telephone No.: Fax No.: Telephone No.: Fax No.: <br />Consultant Name: C' <br />Mailing Address: ` <br />City:<C- +/) e,�YI State• -Zip:/ <br />Representative: J�le: <br />Telephone No.. o.: <br />B. WASTE STREAM IDENTIFICATION <br />Site Address: <br />Description o <br />Process genet <br />Transporter:_ <br />Mailing Address: <br />City <br />Representative:_ <br />Telephone No.:_ <br />State Zip: <br />Title: <br />Fax No.: <br />C. WASTE STREAM DESCRIPTION <br />1. Waste Type: 1% Soil ❑ Sludge ❑ Ash ❑ Treated Wood ❑ Debris ❑ Asbestos ❑ Other <br />2. Anticipated Volume: Tons 414) Cubic Yards # of Drums Other <br />3. Method of Shipment: )d Bulk solid ❑ Containerized ❑ Drums 4. DOT Proper Shipping Name: <br />5. Shipping Frequency: ❑ Monthly ❑ Yearly )KOne Time ❑ Other <br />6. Asbestos Containment Method: ❑ Bags ❑ Cartons ❑ Drums ❑ Wrapped ❑ Other <br />7. Physical State: *X Solid ❑ Slurry ❑ Paste ❑ Powder ❑ Other 8. Percent Moisture: <br />9. Odor: ❑ Strong ❑ Mild 1 None 10. Color of Material:_ u 1 11. pH: 5 eo e d <br />12. Soil Type: % Sand Silt Clay 3. Free Standing Liquids: ❑ Yes 'KNo <br />D. ANALYTICAL SUMMARY (ATTACH ALL CERTIFIED LAB RESULTS AND CHAIN OF CUSTODY DOCUMENTATION) <br />TOTAL PETROLEUM <br />HYDROCARBONS <br />(Specify Method - e . 8015) <br />AVG HIGH Units BTEX (EPA 8020) AVG <br />(ppm <br />/ Ib) <br />HIGH <br />Units <br />(ppm <br />/ t b) <br />Gasoline <br />Benzene <br />Diesel <br />pip M Toluene <br />Motor Oil or TOG <br />Ethvlbenzene <br />Other: <br />Xvlenes <br />VOLATILE ORGANICS <br />(Specify Method - e.g. 8260) <br />List Detected Analytes: <br />SEMI -VOLATILE <br />ORGANICS (EPA 8270) <br />List Detected Analvtes: <br />P <br />,0 .0 <br />o <br />O <br />h4 0 <br />Other Analvtical Methods: <br />Other Analvtical Methods: <br />-ow <br />