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PACIFIC REGIONAL LANDFILL <br /> AN ALLIED WASTE COMPANY <br /> i! <br /> Client: �,�s-. Landfill: <br /> ,-jr <br /> Contact: �y- � - ", ; ; U.; Generator: Ga 0 Phone#: '7 - Sales Person: <br /> Quantity: 2522C J Site: <br /> Reviewed By: Address: mac,' �'< <s-rQ U-1 C <br /> Waste Profile Form Accept Job# <br /> Chain of Custody I Accept Approval#: <br /> ❑ Gasoline Contamination ❑ Ash <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> BTEX ❑ Accept pH ❑ Accept <br /> TTLC Pb ❑ Accept <br /> ❑ Diesel/Virgin Oil Contamination ❑ Hydraulic Fluid <br /> TPHd ❑ Accept TPH-hf ❑ Accept <br /> BTEX ❑ Accept BTEX ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept <br /> Waste Oil Contamination ❑ Sludge <br /> TPH-g ❑ Accept TTLC CAM 17 Metals ❑ Accept <br /> TPH-d ❑ Accept VOCs ❑ Accept <br /> TOG ❑ Accept SVOCS ❑ Accept <br /> VOCs ❑ Accept Paint Filter ❑ Accept <br /> SVOCS ❑ Acce t TPH ❑ Accept <br /> TTLC CAM 5 Metals ❑ Accept Reactivity, pH ❑ Accept <br /> PCBs ❑ Accept <br /> ther ❑ 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 1 Q Barium Nickel <br /> Other: CA Beryllium MD Selenium A/ <br /> Benzene Cadmium oig Silver N <br /> Total T.E.X. c . Chromium Thallium <br /> Total HVOC's Chromium 6 Vanadium <br /> Total SemiVoc's Cobalt Zinc 3 <br /> Other: Copper <br /> NOTES: Lead <br /> Cir Q DATE: 7 "'A'glq L <br /> DISPOSAL: ❑ CLASS II SOIL <br /> PRE-LIEN YES NO Check w/Management <br /> 01 y <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 />