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STURGEON It SON, INC. <br /> Transportation Services <br /> (661) 322.4408 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> NAM> 1�+ s'i &fy' lJy.� .J :A .• . Ftik t`" r <br /> f { EPA <br /> ADDRESS '< f ll t�f/ 4��w E r �.:y.t d� x.., . �i' if Jes+ NO. ' <br /> CITY.STATE,ZIP JAM ✓ •"a PHONE NO. � M <br /> CONTAINERS: NO, 74 VOLUME 9 WEIGHT <br /> O <br /> QTANK <br /> Q TYPE- ❑ TRUCK ❑ TDRUCK ❑ DRUMS ❑CARTONS ❑OTHER <br /> .Z <br /> lit <br /> WASTE.DESCRIPTIOF GENERATING PROCESS <br /> t7 ,f- <br /> R) COMPONENTS OF WASTE PPM 96 COMPONENTS OF WASTE PPM % <br /> 40 <br /> W � <br /> 6. <br /> O <br /> 4J �' 7' <br /> Im <br /> 0 4 Q. <br /> e— 011 <br /> PROPERTIES: 0 r OLSOLID ❑ LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTRUCTIONS: j <br /> THE GENERATOR CERTIFIES THAT t. + <br /> THE WASTE AS DESCRIBED IS IOD% <br /> NON-HAZARDOUS <br /> TYPED INTED FULL NAME d SIGNATURE DATE <br /> EPA 1 <br /> NAMEr .�+ !•.tac� ,�✓` n. NO. I ( ( ( I <br /> LU <br /> ADDRESS. r � ""` �" Y SERVICE ORDER NO. <br /> Z CITY,STATE,ZIP / �`"� 1 ✓f V., t`yf PICK-UP DATEir PHONE NO, <br /> + � <br /> i��tit: .t?J ! r' P "`��+s r'A f i iyr...t� �c'�.(a•t',`nrt=i.' ,.E'•✓F-•..�.C�°,e'� <br /> TRUCK.UNIT.1.0.NO TYPED-OR-PRINTED FULL NAME 6 SIGNATURE DATE �1 <br /> EP <br /> NAME /v Tri.-/ � ..+.. li.+'r>f.J t y, ld'.aw✓(,+� a. t�+ NO 1 1 1 <br /> DISPOSAL METHOD <br /> ADDRESS ' I �rr " Fp♦ (3 LANDFILL ❑�OTHER <br /> j ' firJ' CITY.STATE,ZIP f� rJ <br /> "7 <br /> Q PHONE NO. ( f1 J <br /> ~ TYPED OR PRINTED FULL NAME l SIGNATURE DATE <br /> GEN OLD/NEW L A TONS <br /> TRANS S 8 <br /> Ci0 RVC0 HwofNONE l.alICREPANCY <br /> �za-r-es <br />