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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: Q Landfill: w a <br /> Contact: Generator: Co- � <br /> Phone#: Sales Person: S, <br /> Quantity: Site: loo g5 <br /> Reviewed By: Address: <br /> Waste Profile Form Acce t Job# <br /> Chain of Custody _,2-Accept Approval#: <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX ❑ Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> DieselNirgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf 0 Accept <br /> BTEX 0 Accept BTEX 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> ❑ Waste Oil Contamination ❑ Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG 0 Accept SVOCs ❑ Accept <br /> VOCs ❑ Accept Paint Filter ❑ Accept <br /> SVOCs 0 Accept TPH 0 Accept <br /> TTLC CAM 5 Metals 0 Acce t Reactivity, pH ❑ Acce t <br /> PCBs ❑ Accept <br /> 0 Other ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas AntimonyMercury <br /> TPH Diesel a?_ Arsenic 43 Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: F0 3— Beryllium A10 Selenium <br /> Benzene , Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium 0 <br /> Total SemiVoc's Cobalt Zinc <br /> Other: Copper <br /> Lead <br /> NOTES: <br /> o rP k_ DATE: <br /> DISPOSAL: CLASS II ❑ SOI <br /> PRE-LIEN YES NO Check w/ Management <br /> 1145 WEST CHARTER WAY, POST OFFICE BOX 6336 <br /> STOCKTON, CA 95206 <br /> 800.204.4242/FAX 209.466.1067 <br /> www.disposal.com <br />