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5 <br /> v <br /> *:.. NON=HAZARD._ .:US WASTE .DATA FORM al <br /> 'SHELL PEIINE COMPANY LP <br /> NAME <br /> P.O. ROX 2648, TSP 1605--l <br /> ADDRESS <br /> CITY,STATE,ZIP ; _ PHONE NQ. <br /> C CONTAINERS:No. VOLUME WEIGHT 400- 1_st& <br /> H <br /> a <br /> cc <br /> Z "HYPE: ❑ TRUCK TANK ©RUCK Dump El DRUMS ❑ CARTONS ElOTHER <br /> W <br /> WASTE DESCRIPTION•'s'{��r���� �fli.�;Cj�j GENERATING PROCESS <br /> COMPONENTS OF WASTE PPM 46 ,_ COMPONENTS OF WASTE PPM % <br /> ui <br /> w ft QFC FIVE13- JAN -0 �41a <br /> 2• �]P:RFF1t1:7tiCFA A'AS7F' WAS?,grin r rfn\'r)E.FD •vnCCnurrlmx-1N'SSF.QUEI{r'UF7�SI7t TTS^— <br /> d. UM'()NAL,7KF.A1�FL,N1 O4 9�:"L 41 _'.r1 't GVI7?iEik ;\C OUaAWI.S ll, EACp-riv ZVI <br /> 9-A' 5 GRAMU0701M.M.6Y'T711:E113',44'lfL1:1 Q 'ii)XIC Sk}b51AN($0.jX ROI-TUGL'H(PR - <br /> 3 it1l FII[:F;+V11;OksiF:tIAI.PRrff1rTl()\,►l;FyC"Y V4 AlX0 R0AYL'R M='F1Fg PROVISTUY•OF , <br /> 0 UCO, UXVAT1tWN {ND i(ECA'-'ERV 4i"I OF 1974 r00bniER wMl APPLICABLE <br /> 1.74)FJ[AL AND STAFF Rl:(iU1,.+Y{,}^;� Cl'*)5]?y A 0t47,'101 HAS ALL OF FHL NECESSARY ' <br /> i'ERUR5 TO ACt 111L'itlir'71t£\CF]) R'ASFE AND ALL 17IE Nj7_UAS SEEN }{Ai�[nr M ' <br /> 4. -1Ct"CO�DIIPGI.-'�� <br /> Q PROI?4Rr1E& pH ❑ SOLID ❑ LIQUID ❑ SLUDGE ❑ SLURRY El OTHER u( )S <br /> HANE�I:INQ INSiRUCTIQNS 24 HOUR FfAFIIR FUG <br /> 'Yr NOW€`;A{r'�JU}A`"'4 y <br /> Vit! -F��3.r,��EL,�i•T�litt�. <br /> t .Y'�nh,f✓`dS �.•• Ck� <br /> TYPED OR PRINTED FULL NAME SIGNATURE s DATE <br /> NAME t <br /> w <br /> 4 ADDRESS __ SERVICE ORDER NO. <br /> ' 4" E V Cab+ 9 A 76 <br /> 110- CITY,STATE,ZIP PICK UP DATE <br /> PHONE NO. {�1 fJr )`�E(! 4 �' r�F• "� r,,,r Rr / ' ' <br /> TRUCK,UNIT,I.D.NO. ' TYPED OR PRINTED FULL NAME d SIGNATI IRt DATE <br /> NAME <br /> IxM-4tiY AN 0 V F—RY014,INN �:�t 7W)2 <br /> .e._•_.��� <br /> 1630 W.17 7 ft S d' �?E DISPOSAL METHOD l y { <br /> ADDRESS O LANDFILL ❑ OTHER E ` <br /> (� CITY,STATE,ZIP ! E - i <br /> LL PHONE NO. (54;1, )w,32-.fit(S <br /> a Com. v( ��.h El l`a t.I1 1"(1 - `). !3''j <br /> (... J�� <br /> TYPED OR PRINTED FULL NAME 6 sibf4ATURE DATE <br /> GEN OLDINEW L A TONS <br /> TRANS S E3 <br /> CIO RTICO HWDF NONE DISCREPANCY <br /> RECEIVING SITE SENDS TO.GENERATOR , z� �1 <br />