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q 3- E6 <br /> I Cys <br /> N° 5850 <br /> V. NON-HAZARDOUS WASTE DATA FORM <br /> NAME USA STATION DkRR PETRO _5 1`�" <br /> EPA <br /> 10 <br /> ADDRESS 749 E. Charter way NO 1010 101019 10 1018171 <br /> ICITY,STATE,ZIP StQ('}C� tOn, CA - PHONE(� �} ) <br />' CONTAINERS No / _ VOLUME 3-.27 ?' WEIGHT <br /> a <br /> TANK DUMP <br /> W TYPE ❑ TRUCK ❑ TRUCK DRUMS ❑ CARTONS ❑ OTHER <br /> I Z <br /> W ,[� E <br /> 0 WASTE DESCRIPTION SOIL GENERATING PROCESS H1 M" <br /> >_ COMPONENTS OF WASTE PPM # COMPONENTS OF WASTE PPM # <br />' <br /> in <br /> cl SOIL e <br /> W <br /> H <br /> W 2 6 <br /> I 3 7 <br /> 0 <br /> V 4 8 <br /> W <br /> m <br /> O PROPERTIES pH SOLID ❑ LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTRUCTIONS <br /> THE GENERATOR CERTIFIES THAT P <br /> t THE WASTE AS DESCRIBED IS <br /> 100%NON-HAZARDOUS <br /> TYPED OR PUINTED FULL NAME&SIG NAT � DATE <br /> y <br /> EPA <br /> W <br /> NAME ALTERNATIVE DISPOSAL, INC No CAD982525024 <br /> ~ ADDRESS 2674 Via Alicia� SERVICE ORDER NO h � <br /> O <br /> NCITY,STATE ZIP Fallbrook, CIA 92028 PICK UP DATE t5�5 <br /> Z PHONE NO 619-723-5871 <br /> F" TRUCK UNIT I D NO <br /> TYPED OR PRINTED FULL NAM &SIGNATURE DATE <br /> I EPA <br /> NAME PEN ROB, INC. No A IZ I Cl 0 10 0 1 01010 11 C I 0 <br /> DISPOSAL METHOD <br /> ADDRESS P.O- DRAWER "G" 0LANDFILL 0OTHER <br /> CITY,STATE,ZIP JOSEPH CITY, AZ 86032 <br /> J <br /> Ua PHONE NO (602) 288-3605 <br /> W <br /> Q TYPED OR PRINTED FULL NAME&SIGNATURE DATE <br /> 610 <br /> GEN OLDINEW L A TONS <br /> TRANS S e l <br /> CIO RT/CD HWDF NONE DISCREPANCY <br />