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Gib on <br /> Environmental <br /> Non-Hazardous Waste Data Form <br />' , EPA ID No <br /> NOMe E P, lif- : t C . Phone 14 vo) (r`�?— <br /> Malling Address F ,22 t2521 y"7 ` <br /> ZGenerating Sete L <br /> Wane A uq <br /> ❑ sou <br /> Estimated Volume D ssl s� TONS/YDS' o Waste Description - <br /> p Components oft wast a PPM Components of the waste PPM % <br /> s <br /> USpecial Handling Instructions )U, B oovl es 0 Goggles 0 Other <br /> enerator carttties that t "qrs os dost ed is 103 nor�-N=rdous <br /> m <br /> Signature of A thorized Agent Date <br />' Name KV4 M;ta.00r� _l EPA ID No <br /> Address - <br /> Lei Truck Unit ID .,11?,4 - <br /> Pick Up Date <br /> Z Order No. <br /> SlgnatU*,e �— Date <br /> Facility <br /> � <br /> ❑ CAD980883177 ❑ CAD981458466 CAD043260702� i <br />' Gibson Environmental Gibson Environmental Gibson Environmental <br /> End of Commercial Dr 401 Cana! Avenue 475 Seaport Blvd <br /> Bakersfield, CA 93308 Wilmington, CA 90748 Redwood City, CA 94063 <br /> id (805) 327-0413 (310) 549-9117 (415) 368-5511 <br /> :d <br /> 3 [)is ec a Release Actual Tons/Gals -L-0 <br /> nature Date <br /> 1A Subsldlary of V LS.,lnC <br /> 3'= trt eun Avenue Suite 200 Bakentleld, CA 93301 • M5/327-8013 • BM/852-3935 • Fax 9051841-0229 <br />