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N 0. 6 63-8 5 8 NON -HAZARDOUS WASTE DATA FORM EPA Milli GENERATING SITE I.D. 0. NAMEGG !E- e, e, i NO PROFILE MR, U NO. 0. BOX 80240 1:6 0 S �Vl LSWJ ',AAY ADORES6' e4 C H 0 SAN -I A M- AR 0 ARI A., CA Q2,380 S -10 K TO N, CA W206 06 PHONE 9 t"M .z CITY, STA , IP NO. -lig Ot It *- 3 E 3 =51:-1481312 4. 8. PROPERTIES: PH — 1-1 SOLID El LIQUID D SLUDGE 11 SLURRY 0 OTHER HANDLING INSTRUCTIONS: THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON -HAZARDOUS. -' i 11 P1= z1 ", hphzIf im'f TYPED OR PRINTED FULL NAME & SIGNATURE Y DATE NAME ADDRESS E- -0, i Al ')- CITY, STATE, ZIP I -L PHONE NO. EPA I.D. SEI -8'r VR F NO. TRUCK, UNIT, I.D. NO. CONTAINERS: No. - IVOLUME EPA TRANS WEIGHT NAME NO. e- /V t'll ADDRESS 2924!52 TYPE: r—i ❑ TRUCK Ei TANK LJ❑ DUMP TRUCK El DRUMS fVf D CARTONS E OTHER WASTE DESCRIPTION NONLIHAZARONUS ORAVEL GENERATING PROCESS II INVER i fGATIC)N iEXCAAIAl 10N) COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM % 2. 8. E 3 =51:-1481312 4. 8. PROPERTIES: PH — 1-1 SOLID El LIQUID D SLUDGE 11 SLURRY 0 OTHER HANDLING INSTRUCTIONS: THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100% NON -HAZARDOUS. -' i 11 P1= z1 ", hphzIf im'f TYPED OR PRINTED FULL NAME & SIGNATURE Y DATE NAME ADDRESS E- -0, i Al ')- CITY, STATE, ZIP I -L PHONE NO. EPA I.D. SEI -8'r VR F NO. TRUCK, UNIT, I.D. NO. TYPED 0Q PRINTEU FULL NAME *.%,aWAT'Vdff_. jrV-K. i L A EPA TRANS S B NAME NO. HWDF NONE ADDRESS 2924!52 CITY, STATE, ZIP! lk,'-jll 'ECA. '--A 95Y -,C' PHONENO.- `- _ PRINTED GEN OLDINEW i L A TONS TRANS S B C/o RTIOD HWDF NONE & SIGNATURE DISCREPANCY SERVICE ORDER NO PICK UP DATE DISPOSAL El LANDFILL 0 OTHER. DATE