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NON-HAZARDOUS WASTE DATA FORM <br /> UNOCAL Marketing <br /> NAME EPA <br /> P. O. Box 5155 '0 C A 0 9 812 1 3 7 8 <br /> ADDRESS <br /> ;L Site:437 E. Miner Ave. , Stockton <br /> P CITY.STATE.ZIP San Ramon Ca. 94583 Station #0187 PHONENO. 15101 277-2368 <br /> 0: 7 /1�� � WEIGHT <br /> ' O CONTAINERS:No } /, VOLUME '7;� <br /> a <br /> W TANK DUMP _ <br /> Z <br /> TYPE: ❑ TRUCK ' TRUCK El DRUMS DRUMS ❑ CARTONS Removal of underground <br /> Wtank <br /> O Ngg oil with Waste Oil GENERATING PROCESS <br /> WASTE DESCRIPTIO <br /> } C % COMPONENTS OF WASTE PPM <br /> COMPONENTS OF WASTE PPM <br /> m <br /> W 1. Soil 99.4— s. N' J <br /> W Waste Oil <0.1 ® V '� -" <br /> ` a Z. APR 0 8 1983 <br /> O 3. Debris <0.1 z 'J A�A� HEALTH <br /> U JT/SEr;VIM <br /> w & <br /> OPROPERTIES: NePuHtral nSOLID ❑ LIOUID ❑ SLUDGE C1 SLURRY ❑ OTHER <br /> ' 'HANDLINGINSTUCTIONS: �3F ACce tance M-1125 Station #0187 -- <br /> 43v- U114044) <br /> THE GENERATOR CERTIFIES THAT I <br /> THE WASTE AS DESCRIBED IS 100% T -,ti`/i."',I/ ,Lj/�G, J /•/ <br /> NON-HAZARDOUS. 1�L J,1 ��I Sl 1 D <br /> TYPED OR PRINTED FULL NAME A SIGNATURE DATE <br /> Dillard Trucking, Inc. Eo C A D. 9 8 1 6 9 2 8 0 9 <br /> No. I I I I I I I I I _1 <br /> ccNAME <br /> W <br /> . O. Box 218 143/22 <br /> P <br /> U SERVICE ORDER NO. <br /> ADDRESS <br /> d Byron, California 94514 �O 7 <br /> Cl) PICK UP DATE <br /> Z CITU.STATE.21P <br /> Q <br /> PIIONENO. $10 1634-6850 2 5 <br /> F TYPED OR PRINTT FULL NAME 8 SIGNA RE ATE <br /> TRUCK UNIT,I.D.NO. <br /> EPA <br /> I.D. C A 7 6 <br /> Laidlaw Environmental Services, Inc. NO. <br /> NAME DISPOSAL METHOD <br /> I <br /> F ADDRESS <br /> 2500 I.Aern <br /> LANDFILL ❑ OTHER <br /> Buttonwillow, California 93206-0787 <br /> U CITY,STATE.ZIP <br /> I LL 800 544-7199 ^ J <br /> 0 PHONE NO. �1,.} I ( y(i�F-' l <br /> ��YD OR PRI, IA /DATE <br /> � - H TYPED OR PRINTED FULL NAME 8 SIGNATURE <br /> GEN OLD/NEW L p` Lh� <br /> NS S B <br /> RT/CD HWDF NONE DISCREPANCY <br /> G/O <br /> i I � <br />