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4 <br /> NON-HAZARDOUS WASTE DATA FORM 93rz�� <br /> NAME Exxon Company, U.S.A. T <br /> to <br /> I ADDRESS" n a ROM 441w, -- - NO <br /> I <br /> CITY STATE ZIP Houston, CA 77310-4415 <br /> PHONESNO ! 510__ 246-870() <br /> rf s r r <br /> 01- CONTAINERS Na VOLUME WEIGHT <br /> I a •� I <br /> Lu TANKDump <br /> fz ��//'' <br /> Z. TYPE El TRUCK 5] TT14UCK ❑ DRUMS ❑ CARTONS ❑ OTHER s <br /> f W <br /> I WASTE DESCRIPTION yon Hazardous Soil GENERATING PROCESS Excavation <br /> mCOMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM re <br /> W I 5ofl 99+% s <br /> I` <br /> W <br />._ -1 2 Gasoline _ 6 <br /> C s 7 <br /> ul <br /> CC C ° . <br /> F PROPERTIES- pH OSOL1D ❑ LIQUID ❑ SLUDGE ❑ SLURRY pTHER <br /> HANDLINGINSTUCT�IONS• Drnf410 <br /> �.�' - - Nom.-�r,. �� - :�' - • _ i}}-..� L -+r ! _` ,{._' <br /> ti -' 3 R •Ar �r .5..Jµ, y ,•"1"R'T tr f , r r �- <br /> THE GENERATOR -CERTIFIES--TfiAT <br /> THE WASTE A$ DESCRIBED 1S 10096 Marla �'aLj£3iI3�.C�7: qe '" +7 <br /> NON-HAZARDOUS-' <br /> TYPED OR PRINTED FULL NAME d t16 DATE <br /> 7cw4. <br /> LC004'� <br /> NAME 'SID <br /> Lu <br /> J �-• .... . .T gym._ w �. - - _ . ^n�'~+. �` '.,sfkrN Y + � "..."^r'�1 J 1 n� <br /> O. ADDRESS SERVICEORDERNO;�*___2000/351 <br /> CL _ t � <br /> - 7 it's <br /> N CITY STATE,ZIP Svren__ nA QLS I L PICK OF DATE J <br /> r Z .' <br /> � oxE'aff�-�"b3Yi`=b 8 SO � - _ f - ".._..... __.r _.... _.,. �� �a• ��,� - - - <br /> TRUCK UNIT I D NO I f"CY] TYPED OP PRINTED FULL NAME a SIGNATURE DATE <br /> EPA <br /> �NRir.rt0 -•. .�.we ays - <br />= NAME Laidlaw Environmental Services <br /> '^g <br /> ie� <br /> J, �u I5P03AL-METH00 <br /> ADpRESS 2500 Lokern Road ; ':`A LANDFILL ,❑ OTHER <br /> CITY STAT Bu>rtonwillow, CA 93206 <br /> _ZIP , - <br /> PHONEN 800 544-7199 <br /> Hp <br /> R PRINTED FULL NAME 8 SIGNATURE :x DATE <br /> _�— <br /> ' OLDINEW L `A TONS <br /> Z« t TRANS S S <br /> C/oRTICD "IWOF,-NONE DISCREPANCY"k, • <br /> .j7 f <br /> rk • 1 i a <br /> r ' <br />