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52758 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> NAME <br /> 3 1 <br /> ADDRESS <br /> CITY,STATE,ZIP PHONE NO. { <br /> 0 <br /> H CONTAINERS:No. VOLUME _ WEIGHT <br /> w TANK DUMP <br /> Z TYPE: Cl TRUCK ❑RUCK DRUMS ❑ CARTONS ❑ OTHER <br /> WASTE DESCRIPTION GENERATING PROCESS <br /> mCOMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM 44] <br /> W <br /> J } 'IT'(FIT;RFN('T:D WAS7i:WAS liANO)I71 Ahi?SFIJRHp FOq Si1BSFi2Ul'M 1�7�ITf <br /> :" :ills{,IL'.T1T1>T<�S:EyAt.k�'i I}f:l7hTAN 1-MV1,or,TOXIC sub gl*AscpCt7f.' uj[ TocenER <br /> 0i !IlI:I'`tVl�[]hVI:\.'A! b'�{!J'!]:i�IU:i tiiq;�l}' WACIOIMANCEWfMIMP PRpVISM <br /> 0� 3• � �STs `x s ;�,-i��1')r 44-1 n ssrfs TOCEni[R WrW APF WABLR ED MAR 2 9 2Q�Q <br /> v •:>F',t tl. AMU S7 kTl: TU:i,l:i.a`�::'�t e2Ku%!_•Y & !NIMT(W I1AS ALI, Oi ,kV PII WSARY <br /> k!�iES TU 4ClF 1 ME RE',M(L,dLlL `%AM: AND ALL D(B WASIX HAS OWN 11A�1(DIt� <br /> W 4. <br /> m <br /> Q PR9:A7IES: .pH �(SOUO ❑ LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTTER <br /> 24 HOUR F-0 RC;EPICrY PHONE NUMUER(E00)424- 1CCH E,MTRI C <br /> HANDLING INSTRUCTIONS: PRQIrII C 4701-12 <br /> racii.ls:y: <br /> F3CY MW 57laza�T <br /> . '370R phT1'Crf'.SGTi 1}A :L R.oxo <br /> RrY Cd. A9�7E �1 1V-'a �. <br /> TYPED OR PRINTED FULL NAME 81 SIGNATURE DATE <br /> r=��fJIElsriP:7C1�rP1ra <br /> NAME <br /> ADDRESS SERVICE ORDER NO. <br /> ICL <br /> I;irls�;�s'nvib,x CA 9.1076 <br /> 0CITY,STATE,ZIP PICK UP DATE <br /> Z- 408 1.10-1C,:ifj <br /> PHONE NO. ) xy <br /> TRUCK,UNIT,I.D.NO. TYPED OR PRINTED FULL NA E&SiAN TURE DATE <br /> f[ci s;y:P3Cl1 �II<Ret�?i,RX. <br /> I''i•ntile ld. 7943Ct4 <br /> NAME ......,..w...,,w....�,._..,_ <br /> ls5?0[sJ.17Yi Sif�11Fi DISPOSAL METHOD ff <br /> ADDRESS ❑ LANDFILL ❑ OTHER <br /> J ' LONG 13EAc:'IiCA 90813 <br /> (� CITY,STATE,ZIP <br /> a SW 43?-574 S <br /> PHONE NO. { ) 57 <br /> l) I - - `., ;�.� _ : __ __ U <br /> TYPED OR PRINTED FULL NAME& NATURE DATE <br /> SEN OLDINEW L A TONS <br /> TRANS S 8 <br /> GIQ RTICO HWDF NONE DISCREPANCY <br /> Mu. 8 1 ftift <br /> RECEIVING SITE$ENDSTO GENERATOR <br /> +' �t <br />