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I <br /> NO. 669093 <br /> NON-HAZARDOUS WASTE DATA FORM r <br /> J 1 EPA <br /> t - I.D. <br /> BP �Nlst Coast ProductsLLC ARCO 5459 NO. <br /> NAME <br /> P.O. Bax 84249 130 S. WILSON WAY PROFILE <br /> ADDRESS .1' ,.aas. �''- 4r:o�•uaS; x .. .,'; <br /> Rancho Santa Margarita, CA STOCKTON..OA 95205 <br /> CITY,STATE,ZIP 92688 PHONE NO. <br /> CONTAINERS:No. VOLUME WEIGHT <br /> NK DUMP <br /> TYPE: ❑ MUCK ❑ TRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br /> NON-HAZARDOUS PRODUCT PIPE & DEBRIS REMOVAL REPLACEMENT <br /> WASTE DESCRIPTION GENERATING PROCESS <br /> COMPONENTS OF WASTE PPM Wo COMPONENTS OF WASTE PPM sYa <br /> PIPE 99-1440/0 <br /> i. s. <br /> ORGANICS <1% BESI <br /> 2, 8. <br /> 4 3. 7- <br /> 4. _10 8. <br /> PROPERTIES: PH ❑ SOLID ❑ LIQUID ❑ SLUDGE ❑ SLURRY Cl OTHER <br /> f WEAR ALL APPROPRIATE PROTECTIVE CLOTHING <br /> . HANDLING INSTRUCTIONS: <br /> .n Via: <br /> i THE GENERATOR CERTIFIES THAT THE I WASTE AS DESCRIBED fS 100% Lam MLmDt cart SESI for Gereerabor <br /> NON-HAZARDOUS. <br /> TYPED OR PRINTED FULL NAME&SIGNATURE DATE <br /> f'X'• - EPA `i <br /> ss Belshire I.D. n.-y <br /> t Nom_ NAME NO. - :iw'.a�.r >"'e.,.3„a�.� ck <br /> } 25971 Towne Cent Diive <br /> ADDRESS <br /> SERVICE ORDER NO. <br /> Lake Sorest,CA 9216:1.0 <br /> CRY,STATE,ZIP PICK UP DATE <br /> 949-4-SO-.5200 <br /> PHONE NO. <br /> {•^;;^ <br /> TYPED OR PRINTED FULL NAME&SIGNATURE r DATE <br /> TRUCK,UNIT,I.D.NO. <br /> Clean Harbors (PPAitton-willow), Inc- EDA ON <br /> �� �.�� '° S i�'a ' ° �� .. <br /> NAME NO. mm <br /> '� pi3i .c ..,�$.,ti`" _ <br /> DISPOSAL METHOD <br /> n <br /> 211W W. Lo�ern Road <br /> ADDRESS ❑ LANDFILL ❑ OT'riER <br /> Butf-on-o iAow: C:4 93206 <br /> tta CITY,STATE,ZIP <br /> _L <br /> 805-762-73a'z <br /> PHONE NO. <br /> TYPED OR PRINTED FULL NAME&SIGNATURE DATE <br /> +` GEN OLDINEW L. A TONS <br /> i <br /> .ti <br /> TRANS S B <br /> RT/CD HWOF <br /> GO NONE DISCREPANCY <br />