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NONHAZARDOUS WASTE DATA FORM <br /> To be completed by: GENERATOR <br /> - SITE: <br /> Name: e o6 JOS* I <br /> Address: E7. 4 h EPA ID* <br /> City, State h Zip: or 0 L ,*'7 Zl�� PHONES 7� <br /> Container * Vols� �, Ileight: lSZ'� <br /> Type: Dumpster Bags pump Truck Drums: y Cartons: Other: <br /> Waste Descripti+- �Z� T- Generating Process: <br /> Componentsg koste PPM Components of Waste DPM <br /> 4 - <br /> Properties: PH: Solid Liquid:q Slud e: Slurry; <br /> Handling Instruction: <br /> THE GENERATOR - RTIFI - T AT• THE WASTE Afi DFSCRIBEQ IS 100% NON HA ARn0Us <br /> T r Print Full NameLV <br /> D e: , <br /> �! L <br /> To be completed by: TRANSPORTER EPA I- <br /> Name: ARS•Inc <br /> Service Order * <br /> Address: Pick up Date: <br /> Phone: 916 64S-2 M Truck IDX: <br /> Print Name: Signature/Date: <br /> To be completed by: TSD FACTLITY EPA ID# 3 <br /> 88952 <br /> Name: ANDERSON LANDFILL Disposal Method : LANDFILL <br /> Address:_ 18703 CAMBRIDGE RD Telephone; 530-347-5236 <br /> City, State & Zip= ANDERSON,s&__jL007 Landfill: X Other: <br /> 1 <br /> Type of Print Full Name Date <br /> Signature Ltne <br />