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&S <br />GEN <br />OLD/NEW <br />NO. HUD <br />TONS <br />TRANS <br />S B <br />NON -HAZARDOUS WASTE DATA FORM <br />HWDF <br />_ EPA ...c'y r k <br />I.D. �� ; <br />NONE <br />.�,a�N7SrIE. � <br />ME <br />;. <br />NAME 2-P t "ES'`i- COAST f�ROOLI�`Ta I €.+� <br />: <br />yE <br />•vim <br />�.�L. BOX 802 t <br />PROFILE - %'..k, <br />:3 SVA( SON �iXA{ NO '34 ��._�..+,�+`-��.» M_ r_. ..a^•r.... <br />ADDRESS <br />i�IJ F �t s.' A!T.Li%Trfilc::,4piTA, CA C425Pe �C+��"#0N, CA 95205 PHONE NO. P42 y41BC 5220 <br />j a= <br />CITY, STATE, ZIP <br />! -ml r'� l g <br />� <br />�"��k �� <br />'Fes- <br />CONTAINERS: Nc x-��r <br />VOLUME WEIGHT <br />TYPE: ❑ TRUCIfv\❑ TRUCK TANK DUMP ❑ DRUMS <br />❑ CARTONS ❑ OTHER _ <br />. <br />tt.�E� 3US GRAVEL GENERATING PROCESS�TE INVEaTE�s�FICJ{'I s��GR�AT�O�� <br />x� <br />r:xt= <br />WASTE DESCRIPTION ju,'IA�,.1�v�^R'sC. <br />COMPONENTS OF WASTE PPM <br />% COMPONENTS OF WASTE PPM % <br />U-- <br />�'�"sC <br />1. <br />5. • .I"''.c� <br />a'iki"i <br />E}. <br />2. <br />8. <br />7. <br />` <br />8. <br />E Fr",y <br />-L•:=^^�° <br />4. <br />PROPERTIES: pH ❑ SOUD ❑ LIQUID <br />❑ SLUDGE ❑ SLURRY ❑ OTHER <br />24-i-f� LUR EtM,�ErRGENCY rHONQ 080&424.93,00 <br />HANDLING INSTRUCTIONS: <br />j <br />iters o.". <br />THE GENERATOR CERTIFIES THAT THE <br />WASTE AS DESCRIBED IS 100% r <br />NON-HAZARDOUS.rry <br />)) har� of ilE=1�34 on Ins-Ahall of _ <br />' a <br />:�" 1Z" <br />TYPED OR PRINTED FULL NAME & SIGNATURE DATE <br />"'*`3`Yi <br />T <br />EPA �,,•• :,YS wy: <br />t 5isj011-1 <br />NO .A.YSS k <br />......,... _...». <br />NAME <br />'rr1�h/T{"'. O i...^a,.. it73`;,t= <br />: v e \,- E�' rEr C' <br />SERVICE ORDER NO. <br />ADDRESS <br />OOTi`IZI.S.. f'S: lvO.i'i. C,• 211I.f <br />PICK UP DATE z '' 71 <br />' <br />CITY, STATE, LP <br />a9 4 C-62 O <br />PHONE NO. � <br />TYPE <br />DATE <br />R�iN1� FU61e A FSt 7�i1:lr ♦ J'+ <br />s <br />TRUCK, UNIT, I.D. NO. <br />ED _ URPA <br />��,pr.44>f.iC�,'t`i �..k�,s?x,,�,,k,'1�ysY�" sf+$" <br />E: X51 <br />g ! VY^, <br />NO R44 .uy.fi5"r.^fffrcerT <br />t«— <br />.�I ~T ?��.','? a i« <br />. <br />}, ca ,fix <br />DISPOSAL MET=HOD <br />NAME <br />"•. t^*' <br />:, : - <br />&KtKq S. r'�i'�i.r't_.•� TH ''£' � <br />❑ LANDFILL ❑ OTHER <br />ADDRESS <br />CITY, STATE, 21P <br />i.v�ry Pf lS^. 11� <br />PHONE NO. <br />&S <br />GEN <br />OLD/NEW <br />L A <br />TONS <br />TRANS <br />S B <br />RT/CD <br />HWDF <br />NONE <br />c/o <br />DISCREPANCY <br />i <br />DATE <br />