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NO. 713519 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> 247th <br /> Goneretoes Nome and Mating Address Generator's Site Address Qf different than mating address) <br /> 7-ELEVEN,INC.. 7-ELEVEN-14117 <br /> P.O. BOX 00741 2726 COUNTRY CLUB BLVD <br /> RANCHO SANTA MARGARITA,CA 02886 STOCKTON,CA 8(3204 <br /> Genoratoes Phone:040400•-6200 <br /> Container type removed from site: Container type transported to receiving facility: <br /> Drums ❑ Vacuum Truck ❑ Roll-off Truck ❑ Dump Truck ❑ Drums X)b Vacuum Truck ❑ Roll-off Truck ❑ Dump Truck <br /> ❑ Other ❑ Other l} <br /> Quantity Quantity Volume " lion <br /> WASTE DESCRIPTION NON-HAZARDOUS WATER GENERATING PROCESS WELL PURGING 1.DECON WATER <br /> IZ COMPONENTS OF WASTE PPM % COMPONENTS OP WASTE PPM % <br /> Ct3 1 WATER . 02-100% 3 <br /> a1 fro <br /> at 2. TIak1. a. <br /> Waste Profile PROPERTIES: pH 7"10 • ElSOLID XM LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTRUCTIONS: <br /> Qeneratdr Poted loud Name Signature Month Day Year <br /> Lady Mouthart•of 0681 on behalf of generator <br /> The Generator certirles that the waste as described to 100%non•huardous <br /> Transporter 1 Company Name Phone# i <br /> PELSH1 RE 049-400x6200 <br /> a T an6(iortor 1Prtnle"'Ped Noma Signature Month Day Yew, <br /> QO.• hens iter wkd mend of Receipt of Materials �«. <br /> (q Ttsneporter2CompenyName Phone# <br /> NIETO &SONS I RUCKING,INC. 714-990-0856 <br /> 856 <br /> Transporter 2PdnledfrypedName Signature Month Day Year <br /> Transporter Adtnowlsdgmen of Receipt of Materials ' <br /> Designated Facility Name and Site Address / Phone# <br /> (5 D6MENNO KER'DOON ;31!?-637-7100 <br /> 2000 N.ALAMEDA ST. <br /> Q <br /> LL COMPTON,CA 130222 <br /> Z <br /> W P e ped Nome Signature jMonth Day Ye7 <br /> Designated racily Owner or Operator.Certification of receipt of materials covered by this data form. <br /> r <br />