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ell <br /> STURGEON Ar soniNC <br /> I r' <br /> Transportation Services <br /> (805)322-4408 . <br /> s� NON-HAZARDOUS WASTE DATA FORM <br /> NAME_4 y/ + f:4! I°+' .,a: 3 c :Y7.`�✓ F _z. .. <br /> fj EPA <br /> ADDRESS _(s f ! {. f✓. r fir. Q�' t•. aw ,.r"{' " f fir. NO. I I <br /> CITY•STATE,ZIP --'"1—• 3 y arca ill 6 71 PHONE NO. j;r <br /> VOLUME '�� '4,WEIGHT <br /> � CONTAINERS: No� ' <br /> O <br /> TANK DUMP o='. <br /> TYPE: ❑ TRUCK ❑TRUCK El DRUMS R❑ CARTONS ❑ OTHER' <br /> r- <br /> .c:e 7 <br /> 0 WASTE DESCRIPTION GENERATING PROCESS - <br /> m COMPONENTS OF WASTE PPM alb COMPONENTS OF WASTE PPM % <br /> G i <br /> 5. <br /> 6. <br /> O <br /> U <br /> W T <br /> to <br /> 0 8. <br /> PROPERTIES: PH ❑ SOLID ❑ LIOU10 ❑ SLUDGE ❑ SLURRY ❑OTHER <br /> HANDLING INSTRUCTION& <br /> THE GENERATOR CERTIFIES THAT - ''• -' - - �` +'�,•xrw <br /> THE WASTE AS DESCRIBED IS 1 :?` <br /> NON-HAZARDOUS. E e i. <br /> TYPED INTED FULL NAME b SIGNATURE DATE <br /> EPA f <br /> NO. <br /> W .� s <br /> ADDRESS ' � [.r/ ru,. It -:.#: /t,''`�' <br /> SERVICE ORDER NO. <br /> 0 <br /> IL /011 <br /> zCITY,STATE,ZIP . y/✓ r ... t 4r_. i .Y r' f` PICK LIP DATE 1" <br /> f. <br /> )�" 70V <br /> F PHONE NO: <br /> rl <br /> TRUCK,UNIT,LD.NO. YPEO OR PRINTED FUt NAME b S! NATURE GATE <br /> NAME 1 pLic- .4,t I'j:l(4. a.. _ r P .NO. (. ( ' i I f <br /> DISPOSAL METHOD ADDRESS ''7�-, '� 1 4 tr-✓ f t �°'''�C. r `,• D LANDFILL ❑ OTHER <br /> / CITY.STATE.ZIP I.. t { 1 .pa.4 t , .. A i % <br /> U f t <br /> PHONE NO. ( �t �. 7`t <br /> LL7 <br /> n <br /> TYPED OR PRINTED FULL NAME 8 SIGNATURE DATE <br /> fGEN OLDINEW L A TONS <br /> TRANS g B <br /> i� <br /> C/O AVCO MYOFNONE DISCREPANCY <br /> r°may' 323-7-66' <br />