Laserfiche WebLink
y' a NO. 697105 <br /> NON-HAZARDOUS WASTE'DATA FORM <br /> BEST# <br /> 2_.i :p <br /> 12 <br /> Generator's Name and Mailing Address Generator's Site Address(it dillerentthan mailing address) <br /> ':roc T �'t=�A`aT ���?fal1C S'u Lit:: Fi:.�RNIC-'fz APIC-10 11103 <br /> SP P.O. 00X kc"0249 <br /> F,,'ai,ICHO S'3A HTA MAM,23ARITA, CA 92-688 I.:3T OC11,7 N, CA 952ND <br /> Generatur'sPhone: <br /> Container type removed from site: Containertype transported to receiving facility: <br /> ,�x <br /> �.I'Plums ❑ Vacuum Truck ❑ Roll-off Truck ❑ Dump Truck ❑ Drums ` ' Vacuum Truck ❑ Rolf-off Truck ❑ Dump Truck <br /> ❑ Olher ❑ Other <br /> t,f Volume <br /> Quantity <br /> Quantity j <br /> O i <br /> Nd HAZE C�,.�L WELL �"'LlRr�il`G !DECON W TEP <br /> I.j�s ._ -�`ti_� � 1����TIw� <br /> L11 WASTE DESCRIPTION GENERATING PROCESS <br /> COMPONENTS PPM <br /> Z COMPGNENTSOFWASTE PPM 9b % <br /> W 7 '-'13f3i4 <br /> 0 js TE i <br /> 3. r <br /> TFI-f R S,'c i <br /> 2. 4. J <br /> 7-1 Cl <br /> Waste Profile PROP✓=RTtEs: PH 7-111 souD Y'uautu ❑ st_uDGE ❑ surftRY ❑ oTHFR <br /> HANDLING INSTRUCTIONS � ? ? L!. :APPROPIRIATr PERSONAL F'(-�;C1`(EC T IV 17(,tf'i� ijiEN i. <br /> i <br /> Month Day Year <br /> Generator Printed/typed Name signature {; <br /> f <br /> Larry Mookha.rf of tFSi on b-01aH 01 gw,7Ear'vOI `.. <br /> The Generator certifies that the waste as described is 100°6 non-hazardous <br /> Transporter 1 Company Name Phone# <br /> LU Transporter 1 Printedfryped Name Signature Month Day Year <br /> a Transporter AcknowIledgment of Receipt of Materials <br /> Phone#Transporter 22Company Name <br /> IIEi() &SONS 1JUNINC- . H-Al1_ 114.41 1M 5 <br /> 5 <br /> Transporter 2 Prinled.typed Name Signatufe - _ Month Day Year <br /> F" ) i t f t ry <br /> Transporter Acknowlecigment of Receipt of Materials j <br /> Designated Facrlity Name end Sita Address Ph°�ej s w d <br /> t l`s'E!°lf'`IO KE.Ff-j()C) <br /> .i 2.300 jq. ,_.L..Af';i <br />