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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: . <br /> ' % Landfill <br /> Contact: Generator:( / ,� ,yY- �L <br /> Phone#: C.2ZL2 to l-- Sales Person: <br /> Quantity: Site: <br /> ti. <br /> Reviewed By: Address: <br /> Waste Profile Form �Rccept Job# <br /> Chain of Custody _, —Abcept Approval#: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX ❑ Accept pH ❑ Accept <br /> TTLC Pb ❑ Accept <br /> Diesel/ ' it 'c'r—ontaminatigp ❑ Hydraulic Fluid <br /> TPI-Id ept TPH-hf ❑ Accept <br /> BTEX Accept BTEX 0 Accept <br /> TTLC CAM 5 Metals 0 Accept <br /> Waste Oil Contamination 0 Sludge <br /> TPH-g 0 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 ❑ Accept TPH ❑ Accept <br /> qpTTLC CAM 5 Metals ❑ Accept Reactivity, pH ❑ Accept <br /> PCBs 0 Accept <br /> 0 Other ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas Antimony -Mercury <br /> TPH Diesel c r?Z Arsenic Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: Beryllium Selenium <br /> Benzene L1,' Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc <br /> Other: Co2per <br /> Lead <br /> NOTES: 5' <br /> a rp� DATE: a o <br /> DISPOdAL: CLASS II ❑ SOIL <br /> PRE-LIEN YES Q04 Check w/Management <br /> to <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 />