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7401 <br /> ENVIRONMENTAL` RECOVERY SERVICES, INC. <br /> 6407 ALONDRA BLVD. • PARAMOUNT, CALIFORNIA 90723 • TSL.(310)630-0366 • FAX(310) 630-2341 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> 5.,. <br /> NAME SJAE EO <br /> ADDRESS <br /> ^c'0 3. 1LnP/)� '11Y No. <br /> TUC.✓T"1^1 Ar?n._ <br /> 'CITY,STATE,ZIP _J�� PHONE NO. 4-- 1 <br /> 3 O CONTAINERS:No. VOLUME WEIGHT :Dr7 <br /> H <br /> Q ; <br /> G <br /> TANK DUMP <br /> W E'I - <br /> .Z TYPE; C3 TRUCK 11TRUCK AJ DRUMS ElCARTONS ❑ OTHER <br /> W <br /> WASTE DESCRIPTION`T' GENERATING PROCESS <br /> mCOMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM % <br /> o FILTEk <br /> W s. <br /> F <br /> W <br /> O a. T <br /> C) <br /> W s. <br /> • O PROPERTIES: ON ❑SOLID ❑ LIOUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTUCTIONS: _ <br /> THE GENERATOR CERTIFIES THAT T'.'sr I U <br /> THE WASTE AS DESCRIBED IS 100%NON-HAZARD US. <br /> TYPED OR PRINTED FULL NAME i SIGNATURE L ✓DATE <br /> EPA <br /> 11 IJ ,t <br /> cw JS L � <br /> Lrn LD. A r., 3' TLS•3E <br /> VJ�� 1 C . NO. <br /> NAME <br /> W <br /> QADDRESS _irSO LTiAE AVE. SERVICE ORDER NO. <br /> O <br /> H CITY.STATE.ZIP SIGNAL D ILL LA ]Od l.. PICK UP DATE <br /> A <br /> j�y v[.I I . / <br /> �l7 <br /> cc PHONE NO. ( Y 9^ <br /> TRUCK.UNIT.I.D.NO. /^ TYPED OR PRINTED FULL NAME A SIGNATURE DATE <br /> EPA' <br /> .u;' :cUTAL FILTEk :I'LLYLLiNL 0 <br /> NO. <br /> NAME <br /> DISPOSAL METHOD <br /> 1 I/J0 L. �LAUJU�I <br /> ADDRESS ❑ LANDFILL <br /> Y MtIV IH <br /> J ENVIRON <br /> v <br /> CITY.STATE.ZIP '�""LL'' i;A "��� ' PERMIT I SERVICES <br /> O PHONE NO. ( <br /> ---DATE <br /> TYPED OR PRINTED FULL NAME 6 SIGNATURE <br /> OEN OLD/NEW L A TONS <br /> TRANS S B <br /> C/O RT/CD HWDF NONE _I--DISCREPANCY <br /> 11.11MoArne nnov r: lrlwnrnrl -TRANSPORTER COPY <br />