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STURGEON & SON. INC_ <br /> Transportation Services - <br /> (805)322-4408 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> NAME <br /> EPA <br /> ADDRESS "1 110C I I I'; 1) i ^ I^ IS I<? N I <br /> CITY STATE ZIP '')AC" :A PHONE No 13I SI 3i 00 <br /> I <br /> CONTAINERS NoVOLUME WEIGHT <br /> O0 <br /> TANK DUMP <br /> W I -YPE ❑TRUCK I0 TRUCK E3 DRUMS C3 CARTONS 13 OTHER <br /> Z <br /> Lu WASTE DESCRIPTION T10H CONT- GENERATING PROCESS 1140FR=��"(1) 7Ak <br /> } <br /> � COMPONENTS OF WASTE PPM °41 COMPONENTS OF WASTE PPM 46 <br /> QIIli <br /> Lu I 5 <br /> al <br /> � I � s <br /> O � <br /> U <br /> w I a 7 <br /> 0 6 8 <br /> PROPERTIES PI+ 11 SOLID ❑ LIOUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTRUCTIONS <br /> THE GENERATOR CERTIFIES THAT - ' <br /> THE WASTE AS OESCAJ13ED IS iOD% / <br /> NON-HAZARDOUSr-h.A K � J�..!..�� '� l11,.+,+-� !r.-;1.• 1 :Y��i 7 <br /> TYPED OR PRINTED FULL NAME d SIGNATURE DATE <br /> EPA <br /> cc NAME �T -S N '�/1.JCIal 4121%z <br /> y i <br /> Uj <br /> fZ ADDRESS �S/ G <br /> SERVICE ORDER NO <br /> CL <br /> Z I CITY STATE ZIP I"� r'I 3 PICK UP DATE 7 <br /> 9C PHONE NO <br /> co Z31 <br /> TRUCK UNIT I D NO TYPED OR PRINTED FULL NAME d SIGNATU E DATE <br /> EPA <br /> NAME -aIBS()N FHVIRQKMEMTAL ;,� CAD 3 a3 0 $ $ 1 7 7 <br /> DISPOSAL METHOD <br /> ADDRESS ' r <br /> ❑ LANDFILL ❑OTHER <br /> } <br /> C— <br /> ❑_ C1FV STATE ZIP r <br /> V <br /> PHONE NO (805) 323-2 173 <br /> Q <br /> H <br /> H <br /> TYPED OR PRINTED FULL NAME i SIGNATURE DATE <br /> GEN DLD/NEW L A TONS <br /> TARNS S g <br /> C/o I>ITI WAW M0A DWAtEPANCY <br />