Laserfiche WebLink
N0. 6b68856 <br />NON -HAZARDOUS WASTE DATA FORM <br />EPA F•F'S'E"S `cs-..,^7ir,,,'� i. ''.`H dq ..rt, <br />...«, GC NEPATING2 ^ 1. D. <br />SITE: ND. <br />NAME __ :t v T t..�t T Prd:.s�U :� i l L U 5469 <br />PROFILE <br />NO. <br />E a ADDRES r. q ;� s� ei�'�yl 'i+�l' <br />r � fit 1P ON, CA C-3,205 PHONE NO. 9 <br />CITY. STATE ( �� )`.6i.Y '5 20}� <br />CONTAINERS: No. VOLUME +' WEIGHT <br />j <br />,s DUMP <br />TYPE: ❑ TRUCK E]TRUCK ❑ DRUMS ❑ CARTONS •. ❑ OTHER <br />WASTE DESCRIPTION + YO � - � { GENERATING PROCESS`ITE {NV52 11GATUDW ' EXCAVATI OND <br />:•r.: COMPONENTS OF WASTE PPM 0A COMPONENTS OF WASTE PPM <br />2 6 <br />S. 7. kyr^ i 0 <br />-12 <br />4. <br />PROPERTIES: PH ❑ SOLID ❑ LIQUID ❑ SLUOGE ❑ SLURRY ❑ OTHER <br />HANDLING INSTRUCTIONS: <br />THE GENERATOR CERTIFIES THAT THE <br />WASTE AS DESCRIBED 18 100% aayt <br />NON -HAZARDOUS. L—k i t a U .r•., a is <br />1 :�.rx�-.�f�a���.t-r rs "'i t-7rr � ;�a P is ear.. r•�n: <br />v=+�F TYPED OR PRINTED FULL NAME & SIGNATURE DATE <br />.... •'s'.`t. EPAMIX <br />,v w <br />NAME <br />ennaa=cc ^^ <br />CITY, STATE, ZIP <br />SERVICE ORDER NO. <br />PICK UP DATE J.. `2 <br />PHONE NO. <br />1. walo1 <br />L A <br />TONS <br />TRANS <br />S B <br />C/Q <br />RT/CD <br />TRUCK UNIT, I.P. NO. ! �;� <br />TYPED OR PRINTED FULL NAME & SIGNATURE <br />EPA <br />i.D• <br />NAME <br />1'�: ?C� < - <br />NO. <br />ADDRESS <br />w{r-::?•,;tri ;__,.; ��^'_%i`.1 M _i �'ii �' <br />CITY, STATE ZIP <br />}� `u;{T' _ ; r^S C' R* <br />PHONE NO, <br />c.. .tet, s4_c' <br />�.•, <br />r <br />• �l �I <br />tf $ <br />PRINTED FULL NAME & SIGNATURE <br />GEN <br />OLD/NEW <br />L A <br />TONS <br />TRANS <br />S B <br />C/Q <br />RT/CD <br />HWDF <br />NONE <br />DISCREPANCY <br />❑ LANDFILL ❑ OTHER <br />DATE <br />DATE <br />