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NON-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, FL 33166 <br /> CONTAINERS 1 VOLUME Approx. 12 yds WEICiHTAPprox. 21 t n <br /> TYPE: [ ) TANK [gj END DUMP I JOTHER <br /> ' WASTE DESCRIPTION <br /> Soil w/waste oil <br /> GENERATING PROCESS <br /> Tank removal & over excavation PPM % <br /> COMPONENTS OF WASTE <br /> N/A <br /> pH [ K] SOLID [ j LIQUID [ ] SLUDGE <br /> [ j OTHER <br /> ' HANDLING INSTRUCTIONS <br /> Wear gloves when handling <br /> ' Generator Certifies that the Waste as Described is 100v/0 Non-Hazardous. <br /> TRANSPORTER <br /> NAME A.S.T. <br /> ADDRESS 3472 Enterprise ;j2-q-t&& <br /> CITY STATE ZIP Ha and CA 94545 <br /> PHONE:1�88�-�6 2-4-36G <br /> SERVICE/P.O. NUMBER 2173 <br /> DRIVER'S NAME&SIGNATURE <br /> TSD FACILITY <br /> NAME Liquid Waste Management <br /> S 565-3 <br /> ' <br /> ADDRESS Highway 58 PHONE: 1-805-762-7366 <br /> CITY STATE ZIP McKittrick CA <br /> DISPOSAL METHOD ;2 aP <br /> TCNNAGERECEIVED> / 7 <br /> i <br /> � <br /> i q p� <br /> Printed Name Si nature Date: /�/ 7 <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: - rY -9'� <br /> GENERATOR SIGNATURE' v o <br />