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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> X33 <br /> Client: Landfill: <br /> Contact: - Generator: <br /> Phone#: Sales Person: <br /> Quantity: (k. Site: z( 1 <br /> Reviewed By: j Address: a Ic ►.�d- <br /> Waste Profile Form Accept Job# <br /> Chain of Custody Accept Approval#: <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX ❑ Accept pH ❑ Accept <br /> TTLC Pb ❑ Accept <br /> 0 Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd 0 Accept TPH-hf 0 Accept <br /> BTEX 0 Accept BTEX 0 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 0 Accept VOCs 0 Accept <br /> TOG ❑ Accept SVOCs 0 Accept <br /> VOCs ❑ Accept Paint Filter 0 Accept <br /> SVOCs ❑ Accept TPH ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept Reactivity, pH 0 Accept <br /> PCBs ❑Accept <br /> ❑ Other ('u 0 Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas /PO Antimony Mercury <br /> TPH Diesel Arsenic Molybdenum <br /> TPH Motor Oil Barium Nickel <br /> Other: Beryllium Selenium <br /> Benzene NO 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 Q <br /> NOTES: <br /> —Z DATE: 7 Q b <br /> DISPOSAL: ;KCLASS II ❑ OIL <br /> PRE-LIEN YES NO 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 />