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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: C h Landfill: ( log <br /> Contact: a r C Generator: a <br /> Phone#: Sales Person: <br /> Quantity: C f' Site: <br /> Reviewed By: Address: <br /> Waste Profile Form Accept Job# <br /> Chain of Custody 4R,Accept Approval#: <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals 0 Accept <br /> BTEX ❑ Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> Diesel it Contamination 0 Hydraulic Fluid <br /> TPHd Accept TPH-hf ❑ Accept <br /> BTEX Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals 0 Accept <br /> Waste Oil Contamination 0 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 ❑ Accept TPH ❑ Accept <br /> TTLC CAM 5 Metals ❑ Acce t Reactivity, pH 0 Accept <br /> PCBs 0 Accept <br /> ❑ Other ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas Antimony Mercury <br /> TPH Diesel Arsenic Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: Beryllium Selenium <br /> Benzene 790 Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc <br /> Other: Copper <br /> Lead <br /> NOTES: <br /> cp� Q DATE: <br /> DISPOSAL: ?rCLASS II ❑ SOI <br /> PRE-LIEN YES NO Check w/ Management <br /> 13.E 9,;�-- <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 />