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r <br />NO. 66885? <br />NON -HAZARDOUS WASTE DATA FORM <br />>`awl _ EPA "YC' ,p„ 7 ,✓ '��+_<S,r, <br />t=ENERA'a INN Sl TER F.D. � � <br />_ N0. ? "52 - t^ <br />R" <br />NAME <br />SP V%S7S i �'+ A5r PP. Q .u1C <br />PROFILEIN:,'f.;S. f"`.a i - d.i 2'r N0Ct' k <br />ADDRE O..}'1.���1 �Ji� :? f�7i13�'+ tfYr�MIL <br />'C ME—s'iy <br />ReiNi. HO S-Att Y A, NIOA=LARI I A, CA 922-588 STOCKTOi'V' CA 02231;; - i <br />ha CITY, STATE, Z!P PHONE N0. �A <br />CONTAINERS: No. �'�l,1j/-' VOLUME 1� t•E wsrGlir <br />-TANK DUMP <br />TYPE: ❑ TRUCK ❑ TRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br />5NASTEDESCRIPTION <br />NQN— 4AZARDQ GRAVELGENERATINGPROCESTEIN'VG•ai{, ,3A}{Kf'!a (EX�-' <br />4,,kTlON) <br />COMPONENTS OF WASTE PPM 3'o COMPONENTS OF WASTE PPM % <br />1. 5. <br />2. 8. <br />3. 7 <br />4. <br />PROPERTIES: pH ❑ SOLID ❑ LIQUID ❑ SLUDGE <br />HANDLING INSTRUCTIONS: 24-H(JU. I ,'OERC:,E 1IL.Y fi �l'Q E: E <br />THE GENERATOR CERTIFIES THAT THE <br />WASTE AS DESCRIBED IS 100% <br />NON -HAZARDOUS. :,/ ,1m ?_4 <br />NAME <br />8. <br />❑ SLURRY ❑ OTHER _ <br />TYPED OR PRINTED FULL NAME & SIGNATURE <br />ADDRESS 2597 l TLIYJ <br />FDO I -fl LL ,s„Z�°iA'C I, CA 5,20110 <br />CITY, STATE, ZIP <br />PHONE NO. W is) Or, UJ <br />EPA <br />I.D. <br />NO, <br />TRUCK, UNIT, I.D. NO. TYPED OR PRINTED FULL NAME & SIGNATURE <br />EPA <br />I.D. <br />NAME AL1,.ItED "V4:ASTE NO. <br />ADDRESS 219= ci L <br />C{TI,STATE, 21P ;@ti'L'2.. ��+".O3��r <br />PHONE NO. <br />? <br />TYPED OR PRINTED FULL NAME & $FGNATUi E <br />GEN OLDJNEW L A TONS <br />TRANS S B <br />RTlCD HWDF <br />C/Q NONE DISCREPANCY <br />DATE <br />. <br />90. <br />SERVICE ORDER NO. <br />PICK UP DATE <br />,f <br />❑ LANDFILL ❑ OTHER <br />DATE <br />DATE <br />