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t i i <br /> NON-HAZARDOUS WASTE DATA FORM <br /> C£NERATOR: <br /> ' NAME Ryder Truck Rental, Inc. Properties and Construction Divis on <br /> ADDRESS 3600 Northwest 2nd Avenue PFIpNE: 415-820-9391 <br /> CITY STATE,ZIP Miami, FL 33166 <br /> CONTAINERS 1 VOLUME Approx. 12 yds WEIGHTAPprox. 21 t n <br /> TYPE: [ ] TANK [xJEND DUMP OTHER <br /> ' WASTE DESCRIPTION <br /> Soil w/waste oil <br /> ' GENERATING PROCESS <br /> Tank removal 5 over excavation PPM <br /> COMPONENTS OF WASTE <br /> ' N/A <br /> a <br /> ' PH [ x] SOLID [ ] LIQUID [ ] SLUDGE <br /> [ ] OTHER <br /> ' HANDLING INSTRUCTIONS <br /> Wear gloves when handling <br /> ' <br /> Non-Hazardous. <br /> Generator Certifies that the Waste as Described is 100% <br /> TRANSPORTER <br /> A <br /> NAME A. <br /> ' <br /> ADDRESS 3472 Enter rise PHONE:�6 <br /> CITY STATE ZIP Ha ward CA 94545 7 <br /> SERVICE/P.O.NUMBER <br /> ' DRIVER'S NAME &SIGNATURE <br /> TSD FACILITY <br /> NAME Liquid Waste Management <br /> ' ADDRESS 565-33 Highway 58 <br /> PHONE: 1-805-762-7366 <br /> CITY STATE ZIP McKittrick CA P <br /> DISPOSAL METHOD Grp <br /> TONNAGERECENED> )�D _ <br /> ' Printed Name, SI nature, Date: <br /> ' GENERATOR HEREBY CERTIFIES THAT THE ABOVE INFORMATION IS TRUE <br /> TO THE BEST OF HIS KNOWLEDGE AND AGREES TO NOTIFY A.S.E <br /> IF INFORMATION CHANGES AND THAT ANY SAMPLES WERE TAKEN IN <br /> ' ACCORDANCE WITH FEDERAL AND STATE PRACTICES. <br /> GENn 1 DATE: <br /> ERA NATU Th'c� I�n-1-ti1 <br /> 1 <br />