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IAN-HAZARDOUS WASTE DATA FORM • <br /> ' <br /> r <br /> :Ryder Truck Rental, Inc. Properties and Construction Division <br /> 3600 Northwest 2nd AvenuePFIONE: 415-8Z0-9391 <br /> E,ZiP Miami> FL 33166ERS 1 VOLUMEAPProx. 12 yds WEIGHTAPProx. 21 t n <br /> [ J TAN END DUMP OTH <br /> SCRIPTION <br /> il w/waste oil <br /> G PROCESS <br /> nk removal 6 over excavation PPM <br /> COMPONENTS OF WASTE <br /> N/A <br /> 3a - <br /> ' PH [ g] SOLID [ J LIQUID ( J SLUDGE <br /> [ ] OTHER <br /> HANDLING INSTRUCTIONS <br /> Wear gloves when handling <br /> ' Generator Certifies that the Waste as Described is 100% Non-Hazardous. <br /> TRANSPORTER <br /> NAME A.S.T. zjrL)-? 6�7� <br /> ' ADDRESS 3472 Enterprise PHONE: 6 <br /> CITY STATE ZIP Ha and CA 94545 2173 <br /> SERVICE/P.O. NUMBER <br /> DRIVER'S NAME&SIGNATURE <br /> ' TSD FACILITY <br /> NAME Liquid Waste Management <br /> ADDPESS 565-33 Highway 58 <br /> ' PHONE: 1-805-762-7366 <br /> CITY STATE ZIP McKittrick CA <br /> DISPOSAL METHOD « <br /> ' TONNAGERECEIVED> /.7 l —/ <br /> Printed Name Si nature, Date:/)24 <br /> /�, 7, 0 VE <br /> CERTIFIES THAT THE ABO <br /> TO THEABEST OF HIES KNOWLEDGE AND AGREES TO INFORMATION <br /> ATS.E IS TRUE <br /> ' IF INFORMATION CHANGES AND THAT ANY SAMPLES WERE TAKEN IN <br /> ACCORDANCE WITH FEDERAL AND STATE PRACTICES. <br /> DATE: B l l <br /> ' ERA �G���:(�� <br />