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PACIFIC REGIONALFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: Landfill: t wa r <br /> Contact: Generator: `"An <br /> Phone#: Sales Person: _ <br /> Quantity: S� Site: ti <br /> Reviewed By: 3' Address: <br /> Waste Profile Form Accept Job# <br /> Chain of Custody ccept Approval#: <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX 0 Accept pH 0 Accept <br /> TTLC Pb ❑ Accept <br /> ❑ Diesel/Virgin Oil Contamination 0 Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf ❑ Accept <br /> BTEX 0 Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> ❑ Waste Oil Contamination ❑ Sludge <br /> TPN-g 0 Accept TTLC CAM 17 Metals 0 Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG 0 Accept SVOCs 0 Accept <br /> VOCs 0 Accept Paint Filter ❑ Accept <br /> SVOCs 0 Accept TPH ❑ Accept <br /> TTLC CAM 5 Metals 0 Accept Reactivity, pH ❑ Accept <br /> p Bs 0 Accept <br /> her j Hca; ❑ Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas M MP Antimony M M Mercury `J N <br /> TPH Diesel Arsenic / Molybdenum Mf--) <br /> TPH Motor Oil IVP Barium 1)4�­r2 Nickel 's <br /> Other: Beryllium Selenium .M <br /> Benzene Cadmium Silver <br /> Total T.E.X. Chromium Thallium �s1 (J <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt L3 i ( zinc / <br /> Other: Q.f,�� M Co er �_-) _ <br /> -�. 0, N Lead LS+Z- <br /> NOTES: x'/11, - <br /> La minp' <br /> DATE: 3 <br /> DISPOSAL: CLASS II 50IL <br /> PRE-LIEN YES NO Check w/Management <br /> Z A c l LA <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 />