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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> is Client: Landfill: F7" r �r <br /> Contact: Generator: <br /> Phone#: Sales Person: : <br /> Quantity: Site: � w_-z • <br /> Reviewed By: Address: <br /> Waste Profile Form ccept Job# <br /> Chain of Custody ccept Approval#: (10 <br /> 0 Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX 0 Accept pH ❑ Accept <br /> TTLC Pb 0 Accept <br /> ❑ Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf 0 Accept <br /> BTEX ❑ Accept BTEX 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> Waste Oil Contamination 1D Sludge <br /> TPH-g 0 Accept TTLC CAM 17 Metals 0 Accept <br /> TPH-d ❑ Accept VOCs 0 Accept <br /> TOG 0 Accept SVOCs 0 Accept <br /> VOCs ❑ Accept Paint Filter C Accept <br /> SVOCs 0 Accept TPH 0 Accept <br /> TTLC CAM 5 Metals ❑ Accept Reactivity, pH 0 Accept <br /> qw PCBs ❑Accept <br /> ther ,` 0 Treated Wood <br /> ORGANICS TTLC/TCLP PPM Metals TTLC/STLC PPM <br /> TPH Gas jyo Antimony A10 Mercury <br /> TPH Diesel Arsenic Molybdenum <br /> TPH Motor Oil Barium 2-Po Nickel P- <br /> Other: Beryllium NO Selenium A/9 <br /> Benzene A, Cadmium O Silver <br /> Total T.E.X. Chromium Thallium r7 <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc qQ <br /> Other: Co per <br /> Lead <br /> NOTES: <br /> c�___orr DATE: 7 7 <br /> DISPOSAL: ❑ CLASS II [ SOIL <br /> PRE-LIEN YES NO Check / anagement <br /> �z <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 />