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Page 1 of 2 <br /> AWED WASTE <br /> GENERATOR WASTE PROFILE SHEET <br /> Waste Profile# <br /> Requested Disposal Facility: /9/./..t.-7- <br /> an <br /> i//,, -� � 5 <br /> an Allied Waste Company <br /> I. Generator Information - Date: -/ /J <br /> Generator Name: <br /> Generator Site Address: 7--e3o <br /> City: County .6;: 49275, State: l Zip: � 2e,/ <br /> Generator State ID Number: /v/4 SIC Code Number: <br /> Generator Mailing Address(if different): <br /> City: County: State: -- -j Zip_ <br /> Generator Contact Name: <br /> Phone Number. 1-06:--,757-- Fax Number: <br /> II. Transporter Information <br /> Transporter Name:Clearcreek Contractors, Inc. <br /> Transporter Address: 32_03 /6-4*- s:1- <br /> City: Everett County: Snohomish J State: WA Zip: 98201 <br /> Transporter Contact Name: Mark McCullouh <br /> Phone Number:425 252 5800 �� Fax Number: 425 252 1093 <br /> State Transportation Number: NA <br /> lIL Waste Stream Information <br /> Name of Waste: yoer7,lj,,,evmjWTmrp- £,912 7 <br /> Process Generating Waste: , 77%/d//,-L_ 47- - 7 ,54a4:04/47f,1-7,4--, <br /> Type of Waste: ❑INDUSTRIAL PROCESS WASTE or[Y]POLLUTION CONTROL WASTE <br /> Physical State: L SOLID ❑SEMI-SOLID ❑POWDER []LI UID <br /> Method of Shipment: 1:1 OTHER: <br /> p ❑BULK DRUM ❑BAGGED D]OTHER: <br /> Estimated Annual Volume: ❑CUBIC YARDS: []TONS: 21:1 <br /> Frequency: VI ONE TIME ❑DAILY ❑ WEEKLY ❑MONTHLY OTHER: <br /> Special Handling Instructions: /vo <br /> IV. Representative Sample Certification n NO SAMPLE TAKEN <br /> Is the representative sample collected to prepare this profile and laboratory analysis, <br /> I YES or I I NO <br /> collected in accordance with U.S.EPA 40 CFR 261.20(c)guidelines or equivalent rules? <br /> Sample Date: //lo/Gb Type of Sample: ® COMPOSITE SAMPLE ❑ GRAB SAMPLE <br /> Sampler's Employer G/l k G ( u ,G L 5 <br /> Sampler's Name(printed): _Tip/ ,4 /ij/f -z Signator es jitr, <br /> ©Allied Waste Industries,August 2000 <br /> -i, <br />