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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> Client: Landfill: r <br /> Contact: M 2r �- Generator: <br /> Phone#: QQ Sales Person: <br /> Quantity: ( -5C1c2- C � Site: 21 m-j 4 to a iz 4%r F— ;z�0 <br /> Reviewed By: ;] Address: - yq <br /> Waste Profile Form ?-Accept Job# <br /> Chain of Custody kept Approval #: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX 0 Accept pH ❑ Accept <br /> TTLC Pb ❑ Accept <br /> ❑ Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPI-Id ❑ Accept TPH-hf 0 Accept <br /> BTEX ❑ Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals 0 Accept <br /> 0 Waste Oil Contamination ❑ Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals 0 Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG ❑ Accept SVOCs ❑ Accept <br /> VOCs ❑ Accept Paint Filter 0 Accept <br /> SVOCs ❑ Accept TPH 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept Reactivity, pH 0 Accept <br /> PCBs ❑ 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 < c( Cadmium Silver <br /> Total T.E.X. Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc <br /> Other: lCopper <br /> Lead Qe <br /> NOTES: C <br /> At 3 /® LZO, <br /> ori SP `4Va- DATE: 7 /Y <br /> DI OSAL: CLASS II ❑ SOIL <br /> PRE-LIEN YES N 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 />