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Aj <br /> PLACER TRACTOR SERVICE <br /> NON-HnZAM)OUS AIAMPEST <br /> GENERATOR NAME 'POR CAL BEYERAGE " GENERATING LOCATION SAME <br /> - <br /> ADDRESS 1080 F FPFtlntjT <br /> CITY, STATE & ZIP PHONE # .. <br /> CONTAINERS: NO. VOLUME WEIGHT r <br /> ��. <br /> "TYPE: TANK ThUCK DUMP TRUCK DRUMS OTI IER I <br /> WASTE DESCRIPTION: SOIL <br /> GENERATING PROCEK REMOVAL . <br /> X01 DESCRIPTION OF WASTE QUANTITY TYPE <br /> W 2. .. a <br /> PROPERTIES: PH SOLID LIQUID SLUDGE SLURRY OTHER i <br /> HANDLING INSTRUCTIONS: <br /> THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 1000%NON-HAZARDOUS AS <br /> DEFINED BY 40 CFR PART 261 OR ANY APPLICABLE STATE LAW, AND HAS BEEN PROPERLY <br /> DESCRIBED, CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTA- <br /> TION ACCORDING TO APPLICABLE REGULATIONS. <br /> e. <br /> AA11A) <br /> TYped or Printed Full a and Signature Date , <br /> PLACER TRACTOR SERVICE <br /> NAME -TRUCK # � _ > <br /> c� P.O. -,. <br /> ADDRESS ' DRIVER NAME _ �. <br /> CITY, STATE & ZIP SERVICE ORDER It <br /> 916-652-5535 ''! <br /> PHONE <br /> c <br /> Ty�ed or Printed Full Name and Signature Dat <br /> HULSEY LANDFILL. .. 9.1638'3-212,2 <br /> DISPOSAL FACILITY """ PHONE # <br /> 85 MAD <br /> Z ADDRESS ' DISPOSAL METHOD <br /> p 95826 <br /> CITY. STATE & ZIPLANDFILL. OTHER <br /> Z4 <br /> A Typed or Printed Full Name and Signature Date ; <br /> DISCREPANCY: ; <br /> _ f F <br />