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From: /074477043 Page: 1/1 Date: 1/21200810:38:25 AM <br /> s <br /> NO. 668866 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> t GENERA.MNG SITE: �A <br /> NO. <br /> 8R VA& II CCA'ST PRODUCTS.9_I 054C9 <br /> NAME -- <br /> .._ PROFILE <br /> ADDRESS -O• t'3CX 8024B -190 S`WLSON WAY No. i�:�d�'�" . <br /> a!v1-1H O SANITAKAROARITA, CA, 92688 STOCKT-ON, CA 95205 <br /> Cm,sTA , PHONE No._1 9d949015109490151052�^G <br /> (� YIA <br /> CONTAINERS:ND. v-S VOLUMEWEIGHT <br /> L1 <br /> TYPE: ❑ TRUCK ❑ TRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br /> "! :� s WASTE DESCRIPTION N ON-RAZ RIOLIS Q-RAVEL oeNeRATI►mPRocEssSITE INVESTIGATION(SXC:,A''VATi0N1 <br /> COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM % I <br /> LLJ <br /> w <br /> g2. e. <br /> O <br /> V. <br /> 'u _ 3. 7. <br /> O 'f 4. <br /> s. <br /> BE5!:1hA012 <br /> PROPERTIES: PH ❑ SOLID ❑ LlOU10 ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> NANDUNG INSTRUCTIONS: 24-HOUP'EMERGENCY PVE: 80CW 24-9300 <br /> cc:fF THE GENERATOR CERTIFIES THAT THE- <br /> WASTE AS DESCRIBED IS 100% 77 -7 <br /> NON HAZARDOUS. L- - a tl L• Zce•O 7 <br /> TYPED OR PRINTED FULL NAME b SIGNATURE DATE <br /> EPA <br /> I• NAME EE'LSHIRE NO. <br /> Ltl?^� <br /> I•• :" 2.597"1 TOi'IarNE :ENTRE FORIVc <br /> ADDRESS <br /> i SERVICE ORDER NO. <br /> :, <br /> .Il: <br /> F00-7-TILL RANCH. CL\9x610 ' <br /> Z ;! CITY,STATE.ZIP PICK UP DATE l •L- �� C� <br /> PHONE NO. (949)4`CG-520C <br /> 1.L'tS �%!n OIt/ <br /> TRUCK,UNIT 1.0.NO. � ? TYPED OR PRINTED FULL NAME S SIGNATURE DATE <br /> L- <br /> CPA l..ri. .r l 1 _ e t <br /> L0. <br /> ;41rr <br /> NAME ALLI EQWASTE No. L I ( ,7 Il�1w1Imo1"rt'.Frw r T, a <br /> DISPOSAL METHOD <br /> .i <br /> ADDRESS 9919 E ALI 1 N PC3AEr <br /> ❑ LANDFILL ❑ OTHER <br /> CrY,STATE,ZIP F d.PITECA. CA 953310 <br /> PHONE NO. 2u6- t 2-4:••7B <br /> LJL <br /> TYPE PRINTED FIAL NAME 8 SIGNATURE �^ DATE -- <br /> GEN OLDINEW L A TONS <br /> errs. ? TRANS $ B <br /> RT/00 H•NOF <br /> IT.. VO NONE DISCREPANCY <br /> i• <br />