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NO. 662.055 <br /> . = <br /> NON-HAZARDOUS WASTE DATA FORM <br /> ,.. SITE., <br /> .�:1_T' ISD .._ •:'-°��4.i�..y_ n .-�''_^. <br /> NarnE USA PETROLEUM CORPORATION USA# 935, <br /> � <br /> ADDRESS 3101 tSGOURA COURT #200 <br /> �• i ] i / �cx'� � i`i4'u � -e -•cis <br /> ASOURA HILLS tNo <br /> _3 cm STATE apCA 91301 <br /> PHONE.NO <br /> aa �i <br /> CONTAINERS:No VOLUME <br /> R <br /> DMP <br /> TYPE: ❑ T�K ❑ TRUCK ❑ DAUMS ❑ CARTONS Cl CTHER <br /> WASTE DESca;PR MON-HAZARDOUS WATER pRoc�a ELL PURGI9GIDECON WATER <br /> DENIDaAnNG <br /> ..y: COM?GNENL$OF Y/a&TE PPM % -' <br /> Cd.1PONENT50F WASTE PpM % <br /> �fG <br /> �`�?ti•_' I vYATER. 99-1000to ' <br /> I.r 5 <br /> CST; /5`3s"ZZ <br /> �Q, • a <br /> PROPERPES. 7`A(L_ Cl SCUD ❑ UOUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLINOINSTRUCTIDNS: cYFAR Al I ArPRr-0UjAT_PRDTEi�Tx41'F <br /> THE GENERATOR CERTIFIES THAT THE <br /> WASTE AS DESCRIBED 19 100% <br /> ���• NON-HAZARDOUS <br /> _ TYpFD OR PRINTED NLL NAME 8 SIGNATURE DATE <br /> TrM-MspoT'oar :'. Transporter *'2 EPA e- �'"�'-� �. T, •s:,.- . <br /> M^ <br /> NAME JTR.D[I f,.J tiL�RVi9{a�cFb.�L <br /> :. :.-. AMPIEss:_2'330 CYt'+�7i�i0iP PRRK LlRI1TC St£ 5S0 �1.Y.s( t: '�•r_r //JJ _�; I 4 <br /> •�SERVIGEOADEP NO �� � <br /> ` - CITY STATE MPCMIEROtd PARK CA 956£.e^ 3E:tl:: ';l ;'F �<•; �._ �7 / r� <br /> t yaxr;, //PICTKUPDATE <br /> . <br /> PHONE,, <br /> - �- TRUCK,UNR,I.O.NO. TYPED OR PRINTED FULL NANES$ pE��/�' PATE C <br /> k : :e.t .•T.R <br /> NAME SkAPt:RT RE:iNING :: t9o7'.'tRC. UNENTA1,. LLi, No "1 `''�•R`'�.lij4�-» '?S.• - <br /> `uWa <br /> :R DISPOSAL METHOD <br /> 0.CDAESS <br /> 700SEAPORI SLVI). <br /> _ ❑ UNDFlLL ❑ OTHER <br /> clTr STATE aPR£'JYJrJ--0 CSIY,CA 94063 <br /> ?y'.;- <br /> 6'e1(��:Ii PHONE NO d'L^`�-4}�• ��l} 1` <br /> ` I09 32G!8Y TYPED OR PAINTED FULL NAME A SIGNATURE DATE <br /> e � <br /> GEN OLDNEW L A TONG <br /> - TRANS S B e ; <br /> "� RTlCD NNCF <br /> CQ NONE DISCREPANCY <br />