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I <br /> NON.-HAZARDOUS WASTE DATA FORM <br /> NAME <br /> ADDRESS <br /> PHONE NO. ( 1 <br /> CITY,STATE,ZIP <br /> VOLUME WEIGHT <br /> O CONTAINERS:No. <br /> H <br /> TANK <br /> ? TYPE: ❑ TRUCK ❑RUCK © DRUMS El CARTONS El OTHER <br /> W <br /> r.it'.ry; .:',ia. ' ;,.-' GENERATING PROCESS <br /> WASTE DESCRIPTION COMPONENTS OF WASTE PPM <br /> COMPONENTS OF WASTE PPM <br /> uj Ji 2. <br /> T <br /> rJ B, <br /> W a. <br /> Q <br /> PROPERTIES: pH ❑ SOLID Q UOUID IJSLUDGE ❑ SLURRY 0 OTHER <br /> HANDLING INSTRUCTIONS: <br /> r6 <br /> TYpEd flR PRINTED FULL'NAME b SI4NATURE DATE <br /> C NAME <br /> SERVICE ORDER NO. <br /> { ADDRESS <br /> i..'s:P PICK UP DATE <br /> CITY,STATE.ZIP <br /> PHONE NO. ( •'. I _ <br /> TYPED OR PRINTED FULL NAME&SIGNATURE DATE <br /> TRUCK,UNIT I.D.NO. i <br /> NAME DISPOSAL METHOD <br /> p LANDFILL ❑ OTHER <br /> ADDRESS <br /> ... <br /> ,- <br /> (� CITY,STATE,ZIP <br /> LLIn PHONE NO. C DATE) <br /> UTYPED OR PRINTED FULL NAME&SIGNATURE <br /> GEN OLDMEW L A TONS <br /> TRANS S B <br /> C10 RT10D HWDF NONE DISCREPANCY <br /> IENERATOR'S PRELIMINARY COPY <br />