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ucr +cry+` +vluo LIQUID 'WASTE MGT INC (805) 762-7696 p,001 <br /> rRi)!I C11LUlt r�9Y�, IL, IY,17751 IJra7 Ittf,IJ r, l <br /> �L 1 V1 4...•.4.1•N.S•.:•L:r't•.411.1•S. v:ihS•.l•V.•A.. <br /> Y1Q U WASTE D APP►.oral no.l <br /> MANAGEMENT,INC. ::Y.h: .:::::::::•:; ::::: ::::•:;: :::::: : . :: ;.: <br /> QZNER1ITQR'8 WASTE PROFILE <br /> A. GENERAL INFORMATION <br /> Generator name%,f 'N- MO& t-A0 1 Transporter nomsi 11.Lf Q- <br /> Address�.1Q� E( -.v Addrfse 2.` ,rr Tris <br /> ,�a4cV, rR 9 376 <br /> .SAN <br /> -TE <br /> Tmhniaal oonlaofl A&0J _ � Technical contact: <br /> Phone: d Fhonrl <br /> General site aotlrltyl�rs1— ° Slate hazardous waste <br /> ouler Ifosns — <br /> proof$$ gshorafln9 waslel LUA rem <br /> Ars any hazardous or potentially hazardous materials stored or used on tits? Yet No <br /> It yas, pleasrllatr OTng tom_ — • . <br /> Bill to. IVA --- Attenilan• <br /> PD Ra 0 P.A./Job noa ' <br /> 3. CHARACTERISTICS OF THC WASTE I �I;�L(\ <br /> Fftl � ern <br /> Tarte Svc 1»u tit . Li ;�,:_ti�l1_ <br /> List any known/suspected h,@**rddtK oomponante: DIC.t Gi st r •. _ <br /> Cheek all that apply (a tninlmum of ons per column): <br /> -Tees v,:.;5 <br /> ClartSir 'w you fa Ode in React?" phyetaa5 stale <br /> �V tumoral , r w I El e1 0 corroahro � Sold <br /> OMNr: � �e � W�et�oA [7 {lnllab{e O 8�a�mld—evEW <br /> 6olar plow No. layeroi pHr )loch polnit- <br /> 44014 greyt%r,_ 0yon3da• X lquwdl- - . X wlldeL <br /> C. ANALYTICAL (Chacckcall that apply) <br /> C1 of +�iatee�rNte ettochb <br /> 017 metole 0 Cryon:c leodLAU SeMersta <br /> 6 Cle.al BTx�i <br /> 0. SHIPPING INFORMATION <br /> Anticipated volume <br /> Baels: r <br /> rA <br /> 0n0 urns 0 Week 0 Month a QudrW 0 Year Eetimalod no. of trucks;.l._.� <br /> t. GENERATORS CERTIFICATION; <br /> V <br /> I hanewtlh mb dy that this saple truly rweemm <br /> tot6v of the obo.eenWNvd veleta. 1 ogres to na.!!fy WK 8 then le <br /> a change>n tlr ppenMotlne process that mcwW result In a change !n U,e mete. I oleo *Wwrire 3 to pulo4Saat�1 <br /> +eap��aMFyy:o the vests,et fYpanto, for int purpose of rooharoclert;atlon. I oer* that au aam lss vers aalaoled <br /> oceordln EPA Y,04 sw�4id and that 4 approp"s chain at ovetod to attoched. I script that atl Inforrwt1on <br /> y e bmllt lhla and Ott dMtvnenL h txnAleta and x:unte as that an Ahavn or suspected hazards haw <br /> .f <br /> it• LO •IS• •N�'• <br /> n <br /> i FACILITY DECISION BILLINO INFORMATION <br /> a Accept 0 Reject 0 1811 0 wu 0 Accept. a Reject 111�n <br /> LWM avoounl nae= <br /> Commenfst <br /> a <br /> 3 <br />