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UOr 11r a J '- GU•JJ QUJ..dy r bJ+j UlL <br /> jib on.', <br /> Environmental <br /> Non' -Hazardaus Waste Data Form: <br /> EPA ID No. <br /> Name Q�t�� Srd Iii r� C Phone - <br /> Mailing Address . P o 5-7 4-f _ . ra-( <br /> Generoting Site . ! � � . .�-) i ,75' 1 .0 2� <br /> Waste: - _ ,� llgtJla--, <br /> ❑ Sall <br /> u Estimated Volume 2- 88Ls&;�A� TONS/YDS <br /> Waste Description: _ <br /> .Components of the Waste QPM '©S Components cfi the Waste RPM 96 <br /> - <br /> w���.� >� <br /> Special Handling Instructions 41 Gloves ❑ Goggies ❑ Other <br /> U ' <br /> enera_is cerrifies That t ie wgve as descnced is n3X-n=rdous. <br /> 12 <br /> �. ,Sign=re otAuthorized Agent Date <br /> Name ; EPA ID No. <br /> Address 's7 Phone <br /> i r l <br /> a j �.��-�._, _ Truck Unit ID <br /> Pick Up Date <br /> L Order No. <br /> . Si natLr �; ! Date <br /> g <br /> L Facility <br /> 0 CAD980883177 0 CAD98},458db6 CAD043260702 <br /> y <br /> - -Gibson Environmental, Gibson Environmental Gibson-Environmental <br /> L! End of Commerclal Dr. 401 CanalAvenue 475 Seaport Blvd: <br /> kersfield C 93308 1Mlrnin ton, CA 90748 Redwood Cl , CA 940.63 <br /> Ba 9 tY <br /> _ (805) 327 (310} 117 (415) 368-5511 <br /> R _ <br /> Dispo od: Rec Release ' Actuai Tons/Gals <br /> Sicnatcfe . S Date_ <br /> L13300 <br /> Icryof V.U.-Inc.Truxtun Ave'nue.Suite 2m eld:CA 93301 • W5/327-0413 80D/852-3935 • �c 805/861-1 '129 <br />