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1:1','13. 2HI 06 53 4039710135 SSS INC, R-CiE 02 <br /> NOa ooi5n <br /> NON-HAZARDOUS WASTE DATA FORM <br /> EPA <br /> NAtAE <br /> Exxon "'1 O b 1 1 N4 rj I`7 Y 1 <br /> A00RESStul JeTFerson `Lai; . Hoorn #127 <br /> Gtii—Eyn—�n� <br /> GITY STATE,ZtP Houston Ix 7 1 0 0 2 PHONE NO ( ti <br /> WEIGHT OR VOLUME UNITS <br /> �c <br /> W <br /> z a ^ <br /> ' TYPE QTANK TRUCK RUMS ❑OUMP TRUCK❑CARTONS ❑UTHER <br /> Lu CONTAINERS '` - - <br /> wABTE vESCRIPTIO G�NEAATI NO gRGGE9 P iu re i <br /> m COMPONUNTS Or WASTE RAM % COMPONENTS OIF V4A&Tfi PPM °° <br /> D <br /> W Water 99-100 S - <br /> Fw 1 — <br /> LU <br /> 3! eetroleum tivcrocaroon.s 1, i a -^--- <br /> 2 <br /> O 7 -- <br /> C� a <br /> W <br /> m 4 tet ^ <br /> PROPERTIES "7-9 ❑3QLIP LIQUID ❑ 84WSjDE ❑ SLURAY ❑ OTHER <br /> HANCLINO INSTUCTIONS Wear A r D r Z a t@ <br /> GENERATOR CERTIFICATION Thlt Is to errtlfY that the aaovit named waste matari.la ara 100% non-nLTard*U5 and are not raoulatad .ceorj- <br /> mNrta6•Ila6{k a Inc CPR araUI EPA) r appi nark s tAtgragiggytation awnw1ditIO;jj t.1 r14 016vt +n�;S6oni matahaic ara PFORVIV awracrlp•a, Ra-ka"d, <br /> Consultatt for Ex on P%Obll <br /> TYPE OA PRINT FULL NAME. St(INATURE DATE <br /> CPA <br /> w NAME <br /> service Station Systems, 1110. No C I AI RI QI I 0 I la I6 rg r8 <br /> 1235 N. Fifth Street <br /> ADDRESS SERVICE:OFICCN NU <br /> San Jose, CA 95112 PICK UP DAT <br /> CITY STATE ZIP E <br /> d <br /> F, PHONENC 408 971-2445 - <br /> ,.,, <br /> Ts <br /> TpUC UNIT l D NO <br /> DOR PRINYEO FULL NAME 3 914NATURE <br /> EPA <br /> [:r e s_b And Overton , i n c . N°v- �;—;- <br /> NAME QISP03AL METHOD <br /> aoarDa <br /> � <br /> I h ill w 1 7th b t r e e ❑ Lnr+as,LL C] oT�+ca <br /> J <br /> ~ITY STAZ k,Dp L o h n 15 B a n 1 u� <br /> ti <br /> PHONENa �b L 1 4,3 1.—!3445 <br /> fA DATE <br /> QUANTITYTYPED OR PRINTED FULL NAME A SIpNATURE <br /> OtSCREPANCY <br /> C a 0 FO RM NO 0 1-74 1 81s9 WHITE-ORIGINAL CANARY-TO TRANSFORTATICN PINK-TC GENERATOR GOLDC,ENERRTOfi <br />