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NO. 668858 <br />NON -HAZARDOUS WASTE DATA FORM <br />��y T EPA ... ,� �,.: s'•' <br />GENERATING .A i I NG SITS' LD <br />NO .4'-S' ..E�r::.,,s:�n...,..:k • t} _..'.�u`" .V"3c-w.. <br />NAME C li!'rti l c0 I R 0 0 Ul �• -S I,L,3F-AF <br />PROFILE <br />ADDRESS '' <br />STOCKPHONE NO. I �Ai:d )4 t O'-..] <br />CITY, ST 7E� 2IP <br />CONTAINERS: No. y,A VOLUME r t r. WEIGHT <br />TANK <br />TYPE: ❑ TRUCK E]TDRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br />WASTE DESCRIPTION NOS' -r IAZARO!_ LIS GPMEL GENERATING PROCESS fF iNVE ¢ IGA;TION 1 EY,CA AMOW <br />COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM % <br />1. 5' <br />2 6. <br />3. 7' <br />S"S1:141,00'11 2 <br />4. - 6. <br />PROPERTIES: PH ❑ SOLID El LIQUID �� ❑ SLUDGE ❑ SLURRY <br />y El OTHER <br />HANDLING INSTRUCTIONS: ��'`�OE-f� �' `-� •,rteS4w. <br />-y. I}1.}'"�t <br />THE GENERATOR CERTIFIES THAT THE <br />WASTE AS DESCRIBED IS 100% <br />NON -HAZARDOUS. %' .!' s G3f'�*yZwFf of P.,P;! gn "tial"' ff of rr%ras-•ia`ir <br />TYPED OR PRINTED FULL NAME & SIGNATURE DATE <br />EPAY='liffl <br />I.D.N0. <br />NAME <br />7597 ' I ? ? ,r.�3'".' �j" ''`+! i L, SERVICE ORDER NO. <br />ADDRESS <br />I'l`; �0 r�i i :'-',.,'44 e�.:i I, • ..�.. CIF'.ii �i',�I <br />CITY, STATE, ZIP <br />PHONE NO, "6 - 2:10;, <br />11r } <br />TRUCK, UNIT, I.D. NO. TYPED 04 PF IRY-C-U FULL NA&lE k6J.'GNAtyLe r1i' <br />EPA <br />I.D. <br />NO. <br />NAME AL <br />ADDRESS: <br />CITY, STATE, Zip � y .IiV:� i ` S":.. "--A 26'33t' <br />PHONE NO, <br />TYPEDAR PRINTED FMLL NAME & SIGNATURE <br />GEN OLDINEW LA TONS <br />TRANS S 8 <br />IRT/CD IHWDF <br />REPANCY <br />C/o 11` NONE DISC <br />PICK UP DATE <br />DISPOSAL <br />❑ LANDFILL ❑ OTHER. <br />DATE <br />