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' *-HAZARDOUS WASTE DATA FORM <br /> GENERATOR <br /> NAME Ryder Truck Rental, Inc. Properties and Construction Division <br /> ' ADDRESS 3600 Northwest 2nd Avenue PHONE: 415-820-9391 <br /> CITY,STATE,ZIP Miami, F7 33166 <br /> ' CONTAINERS 1 VOLUME Approx. 12 yds WEIGHTApprox. 21 t n <br /> TYPE: [ j TANK [X END DUMP OTHER <br /> WASTE DESCRIPTION <br /> Soil w/waste oil <br /> GENERATING PROCESS <br /> ' Tank removal & over excavation <br /> COMPONENTS OF WASTE PPM <br /> N/A <br /> pH [ X] SOLID ( ] LIQUID ( ] 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. <br /> ADDRESS 3472 Enter rise `�/5 37at'�7 <br /> ' CITY,STATE,ZIP Ha and CA 94545 PHONEY�96�- �6 <br /> SERVICE/P.O. NUMBER 173 <br /> DRIVER'S NAME&SIGNATURE <br /> TSD FACILITY <br /> NAME Liquid Waste Management <br /> ADDRESS565-33 Highway 58 <br /> CITY STATE ZIP McKittrick CA PHONE: 1-805-762-7366 <br /> DISPOSAL METHOD <br /> ' TCNNAGE RECEI D> o • q <br /> -r-7 <br /> E/Mfl- J/// /NtS rzi� _ 9� G <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 /> ( DATE: <br /> ' GlTTI e iCIGTU�RE � C� �Gc C� lq <br />