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Gibson o <br /> Environmental -- <br /> Non-Hazardous Waste Data Form <br /> f�. <br /> p EPA ID No. LcJA'1 z1alaovag 67a <br /> a Name?{ , /, Phone s, . � ��'? . v - Z__ <br /> Mailing Address (.Alai 7"Cd Woo," V <br /> Lu Generating Site Y v <br /> LU Waste: ❑ Liquid asoil <br /> Estimated Volume BBLS/GALS U TONS/,YDS.) <br /> m Waste Descripon: <br /> ❑ Components of trrte Waste PPM % Components of the Waste PPM % <br /> LU <br /> LU <br /> pSpecial Handling Instructions 0-Gloves E- Goggles ❑ Other <br />' m Generator _ at e waste as described is 100% non-hazardous. <br /> O �- .. <br />' Signcrrure of Authorized Agent , Date <br /> Name c/.,j fly�' ��;,.r .. -r, ; amu. ' _ EPA ID No. <br /> Address Phone __ r - y�'w `• r_-r� <br />' p !r' T� Truck Unit ID <br /> y Pick Up Date <br /> Order No. <br /> ccZ f <br /> Signature Date <br /> Facility <br /> 1 <br /> aCAD980883177 ❑ CAD981458466. .- - ❑ CAD043260702 <br /> {j Gibson Environmental Gibson Environmental Gibson Environmental <br /> ,Q End of Commercial Dr. '401 Canal Avenue 475 Seaport Blvd. <br /> Z Bakersfield, CA 93308 Wilmington, CA 90748 Redwood City, CA 94063 <br /> O (805) 327-0413 {310) 549-9117 (415) 368-5511 <br /> m <br /> (D Disposal Method: Recycle Release #_f G w Actual Tons/Gals <br /> Si nature Date <br /> A Subsidiary of V.L.S., Inc. <br /> 3300 Truxtun Avenue,.Suite 200 • Bakersfield, CA 93301 • 8055/327-0413 • 800/852-3935 Fax 805/861-0229 <br />' White-Gibson Copy ..Yellow-Gibson Returns to Generator • Pink-Transporter a Goldenrod-Generator Retains Copy <br /> .- _ - - - .. - - .. . _, :•t.'. .:HJR,... _. ..- ._._._-... � _.�_ �.�..... .�..�_. ' <br />