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PACIFIC REGIONAL <br /> AN ALLIED WASTE COMPANY <br /> Client: Landfill: — �r <br /> Contact: ,' Z Generator: c fff a medz Pt <br /> Phone#: 3 Q Sales Person: <br /> _ <br /> Quantity: Q s Site: S� <br /> Reviewed By: Address: 2 <br /> Waste Profile Form nccept Job# <br /> Chain of Custody Ucrept Approval#: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g 0 Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX ❑ Accept pH ❑ Accept <br /> TTLC Pb ❑ Accept <br /> ieselNirgin Oil Contamin tion ❑ Hydraulic Fluid <br /> TPHd Mccept TPH-hf ❑ Accept <br /> BTEX crept BTEX ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> ❑ Waste Oil Contamination ❑ Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals 0 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 ❑ Accept Reactivity, pH ❑ Accept <br /> PCBs ❑Apt <br /> ❑ Other ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas g Antimony No MiD Mercury D <br /> TPH Diesel I a0 Arsenic </ q ! Molybdenum MD ND <br /> TPH Motor Oil /62 Q GO Barium _3 Nickel �-3 ( <br /> Other: Beryllium .0 1VD Selenium /V'D <br /> Benzene 0 Cadmium </ .41 Silver <br /> Total T.E.X. Chromium (, Thallium <br /> Total HVOC's Chromium 6 Vanadium ! 7 <br /> Total SemiVoe`s- Cobalt Zinc A <br /> Other: Copper <br /> ]Lead �- <br /> NOTES: a ;V., I <br /> . n <br /> cL< P C�V DATE: 'Vl Q <br /> DIS SAL: CLASS II IL <br /> PRE-LIEN ES NO Check w/Management <br /> l p rl(o7 <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 />