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NON-HAZARDOUS WASTE DATA FORM <br /> NAME S^CTLTLP'iD COF.'r^.3hC'Cfl <br /> EPA <br /> ADDRESS £OSP IM"CL ?G;: ,7, ID. r, 1 41616. 4 G. <br /> No <br /> CITY.STATE.ZIP FL: <br /> PHONE NO <br /> Q <br /> 0 CONTAINERS:No VOLUME WEIGHT <br /> Q <br /> W TANK DUMP <br /> Z TYPE: ❑ TRUCK O TRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br /> W <br /> .]-:OL,Tt:r CONT?-'VINAM, SAIL. <br /> Y WASTE DESCRIPTION � GENERATING PROCESS TANK 'vL'1,?( <br /> m COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM <br /> c <br /> W I :iC s -e7PY . F NT' i2 <br /> F <br /> W <br /> .Ja 7. 9T]NZENE <br /> Q 0 TOLUEIIL z <br /> V 7 I <br /> m <br /> or ci� A <br /> F PROPERTIES: PH ❑SOLID ❑ LIOUID ❑ SLUDGE 13SLURRY ❑ OTHER <br /> HANDLING INSTUCTIONS: <br /> THE GENERATOR CERTIFIES THAT <br /> THE WASTE AS NONHAZARDOUS.ESCRIEIED IS 100% IA/A !7—�� <br /> VTYPED OR PRINTED FULL NAME i/SIGNATURE DATE C r <br /> EPA <br /> w NAME Dwight Trucking, Inc. eo C A D 9 a 0 6 9 7 Y 3 <br /> W <br /> F <br /> O ADDRESS P.O. Box 81675 SERVICE ORDER NO <br /> CL <br /> Z CT'.STATE,ZIP Bakersfield, Caitfornta 93M PICK Uv DATE <br /> Q /, <br /> H Poco. (805) 399.1877 —•�- /� /,.., . <br /> TRUCK UNIT.I.D.NO. D lit I G 7VPED OR PRINTED FULL NAME!SIGNATURE' DATE <br /> EPA <br /> NAME 'i, '. v7 ty r O I.D. 1 n C) r• <br /> NO. <br /> j <br /> DISPOSAL MEIKOD i p <br /> F ADDRESS ❑ ANOFILI OTNE �\ <br /> J "C',-T—Ti:!Ct:, r 11 <br /> /�A1Orc:zLA '-).1.:ri <br /> V CITY.STATE.ZIP - �L <br /> M.4,Z. 7;yfi -Do L4 <br /> U. <br /> PHONE NO. (;:-) --%f <br /> Cl <br /> F �*PPb OR PRINTED FULL NAME A SIGNATURE E may^'-�' � n DATE <br /> GEN OLD/NEW L <br /> TRANS SE <br /> GO RT/CD HINGE NONE DISCREPANCY <br />