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�a U 2925 <br /> �N, 9 <br /> MON HAZARDOUS WASTE DATA FORM <br /> 7 <br /> 192259 <br /> eneratofs Name end Malting Address Generators Site Address(lf dMerent then matting sddr <br /> CONOCOPHILLIPS RM &R CONOCOPHILLIPS*11195 <br /> 76 BROADWAY 18600 S. HARLAN RD. <br /> SACRAMENTO,CA'95818 LATHROP,CA 95330 <br /> ATTN: SHELBY LATHROP EWIRONMENTAL V EALV <br /> Generator's Phone: $16-598-7666 PERMIT/SER,J4CES <br /> Container type removed from site: Container type transported to receiving facility: <br /> 6Xbrums ❑ Vacuum Truck ❑ Rolloff Truck ❑ Dump Truck ❑ Drums x6 Vacuum Truck ❑ Roll-off Truck ❑ Dump Truck <br /> ❑ Other ❑ Other <br /> e) . ft� <br /> CCQuantity Quantity Volume /-'v-r" <br /> 0 <br /> W <br /> WASTE DESCRIPTION NON-HAZARDOUS WATER GENERATING WELL PURGING/DECON WATER <br /> W NTS COMPONEOP WASTE PPM % OOMPONENTS OF WASTE PPM % <br /> C3 WATER 99-100aYa <br /> TPH a1°k <br /> z d• <br /> Waste Profile mopurnes: pH 7-10 ❑ soul) Y16 uowo ❑ SLUDGE ❑ SLURRY C1 OTHER <br /> HANDUNG INSTRUCTION& <br /> Generator P&&9d/rypad Name Stgnat_ Month Day Year <br /> Larry Moothart of BESI on behalf of ConocoPhi lips Company 15,119111 , <br /> The Generator certMess that th waste es described Is 100%non hazardous <br /> T"m <br /> SHIRE yName Phone# <br /> 9494e0-5200 <br /> LLJ 7rder1Printed/lypedName Signature Month Day Year <br /> C) <br /> a T edgment of R at of Mrws <br /> TrenaportME 1 0 IN NS TRUCKING,INC. X114 99(I-6885 <br /> _Trapgpgagr Z Pttgd(fypeQ►de Signature Month Day Year <br /> 15b7 <br /> Iter AcknowledgRteM of Reoelpt of Matellers <br /> "M637.7100 <br /> =1 2aa0 N.ALAMEDA ST. <br /> Q <br /> COMPTON, CA 90222 <br /> I%lel ' <br /> UOUt_ <br /> ff_1W You <br /> W P ame slgrrahxe °" <br /> w � Z <br /> Dbfgmted F,prRy Owner or peralor CsAification receipt of materiels omred by We data form, <br />