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F LACER TRACTOR SERVICE ' <br /> NON-HAZARMUS MST <br /> NOR CAL BEVERAGE , <br /> GENERATOR NAME A <br /> 1 080 E. FRfr�lar�T GENERATING LOCATION „ n <br /> _ <br /> .ADDRESS <br /> STOCKTONA CA. 95205 209-943-0381 <br /> CITY, STATE & ZIP PHONE # I <br /> CONTAINERS: NO. - 1 VOLUME WEIGHT �I } <br /> I <br /> TYPE: TANK TRVff UMP TRUC DRUMS OTHER <br /> WASTE DESCRIPTION: N ' GENERATING PROCESS <br /> L DESCRIPTION OF WASTE QUANTn`Y � .IypE <br /> F , <br /> w 2. <br /> i <br /> PROPERTIES: PH SOLID LIQUID{ SLUDGE SLURRY OTHER i <br /> 5 <br /> HANDLING INSTRUCTIONS: .. <br /> THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 100%NON-HAZARDOUS AS <br /> DEFINED BY 40 CFR PART 261 OR ANY APPLICABLE STATE LAW, AND HAS BEEN PROPERLY ; <br /> DESCRIBED, CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTA- <br /> TION ACCORDING TO APPLICABLE REGULATIONS. <br /> Typed or Printed Full Name and Sig ature, �'�Date <br /> PLACER TRACTOR SERVICE ' x <br /> NAME - -:: TRUCK <br /> ADDRESS DRIVER NAME` <br /> . :.N; <br /> a. -CITY, STATE & ZIP SERVICE ORDER # ' <br /> 916-652-5535 " . <br /> PHONE rt <br /> Typed or Prinked Full Name an Signa re'_ Date <br /> HULSEY LANDFILL 916-383-2122 <br /> DISPOSAL FACILITYN' PHONE # <br /> ;h <br /> ADDRESS D SPOSAL METHOD <br /> O <br /> CITY, STATE & ZIP . LANDFILL : OTHER <br /> A Typed or Printed Full Name and Signature Date k <br /> DISCREPANCY: = . <br />