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NON-HAZARDOUS WASTE DATA FORM <br /> NAME L:NC'CAL M8r4etinR EPA <br /> ADDRESS P. J. SUR ii5 NO. C ,, J ` I <br /> Site:437 E. Miner Ave. , Stockton <br /> CITY,STATE.ZIP San Ramon Ca 9.583 SL" ion +h-)197 PHONENO 1510, 277-2368 <br /> 0 CONTAINERS:No. 7-0-0 " / " VOLUME WEIGHT <br /> Q <br /> 2 <br /> w TANK DUMP <br /> Z TYPE: C1TRUCK x TRUCK ❑ DRUMS ❑ CARTONS ElOTHER _ <br /> Wqq Removal of underground <br /> 0 WASTE DESCRIPTION-011 With Wag to 011 GENERATING PROCESS tank <br /> m COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM % <br /> O <br /> W i. Soil 94-9 s <br /> F <br /> J Waste 011 <0.1 e A'"y <br /> IL IL z <br /> 0 3 T <br /> U <br /> LU e <br /> CD a. <br /> OPROPERTIES: NeL ralSOLID ❑ LIQUID ElSLUDGE SLURRY ❑ OTHER <br /> HANDLING INSTUCTIONS: A--F—m M. –In <br /> THE GENERATOR CERTIFIES THAT <br /> THE WASTE AS DESCRIBED IS 100% <br /> NON-HAZARDOUS. o u/o!w h/t `J •la'f..i"�' '�����gZ' <br /> TYPED OR PRINTED FULL NAME 8 SIGNATURE DATE <br /> EPA <br /> Dillard Trucking, Inc. D. A 6 OI 9 <br /> NAME NO. <br /> W <br /> M <br /> P. O. BOX 218 SERVICE ORDER NO. 14393 <br /> ADDRESS <br /> a . Byron. California 94514 <br /> y CITY.STATE,ZIP PICK UP DATE <br /> Z <br /> Q n / <br /> PHONE NO. Ill 634-68/4/0 <br /> ~ TRUCK UNIT.I D.NO. �J TYPED OP PRINTED FULaNAME 8 SIGNATURE L/' P�—�D DAT <br /> EPA <br /> Laidlaw Environmental Services, Inc. No C 6 i 6 <br /> NAME <br /> \� DISPOSAL METHOD <br /> Y ADDRESS 2500 Lokern Road LANDFILL ❑ OTHER <br /> F' <br /> J Buttonwillow, California 93206-0787 <br /> V <br /> Y.STATE,ZIP <br /> LL PHONE NO. 800 544-7199 <br /> Q <br /> f. TYPED OR PRINTED FULL NAME 8 SIGNATURE / _ DATE <br /> GEN OLD/NEW L A <br /> TRANS S B O D <br /> C/O RT/CD HWDF NONE DISCREPANCY <br /> • <br /> 1 <br />