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NO. 712396 11 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> rES1# 242196 <br /> Generator's Name and Mailing Address Generator's Site Address(2 different then matting address) <br /> 7-ELEVEN, INC. T-ELEVEN 13970 <br /> P.O. 13OKS0741 1899 N.MAIN ST. <br /> RANCHO SANTA MARGARITA. CA 92088 MANTECA,CA 95336 <br /> Gmsratoes Phons: - <br /> Container type removed from site: Container type transported to receiving facility: <br /> )Q(Drume ❑ Vacuum Truck ❑ Roll-off Truck ❑ Dump Truck ❑ Drums x)l Vacuum Truok ❑ Roll•oft Truck ❑ Dump Truck <br /> ❑ Other ^ ❑ Other <br /> Quantity /�_ Quantity Volume f J <br /> WASTE`DESCRIPTION NON-I4A7ARr)Q1 IS WATFIR GENERATING PROCESS t�_pl iRnImra i nt=r~htd IArAIM <br /> W <br /> W COMPONENTS OF WASTE PPM 9i OOMPONENTS OF WASTE PPM % <br /> >. WATER 9ta-ion°k a. <br /> 2. TPH —_<j% a. <br /> Waste Profile PROPERTIES: pH_!� ❑ SOLID UWID ❑ SLUDGE ❑ SLURRY ❑ OTHERS_ <br /> c <br /> HANDLING WSTRUCTIONS: <br /> Generator Pdnted/rypedName Signature Month Day Year <br /> t! <br /> The Qeneratof cerUcee that the waste as described le tcox non•tiaxerdous <br /> Tiansporter 1 Company Name Phone# <br /> a SELSHIRE 8A9-4.00.5200 <br /> Transporter 1 P(Wod/ryped Name Signature Month Day Year <br /> O <br /> ans kn gment of R pt f Ma <br /> (n lreneporter 2 Com any Name Phone# <br /> Z NI EFO&SONS TRUCKING,INC. 719-0nfl•t3856 <br /> Transporter 2Pdnied["ed Name Signature:r ✓i��r� Month Day Year <br /> 41 <br /> nnspodsredgment of Recelpt of Materials ' <br /> Designated Facility Name and She Address Phone/ <br /> DEMENNO KERDOON 310-537•-7100 <br /> J 2000 N.ALAMEDA,ST. <br /> U <br /> tQ COMPTON, CA 80222 <br /> C7 ' <br /> Z_ <br /> > <br /> W PrIntedflyped Name Signature month Day Year <br /> U <br /> W /, i <br /> or. <br /> &slgnalad Facia Owner or gatCerdgoadaIpton of oT fits s covered by this data foim. r r' <br />