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- - . , . - �__ ` • .. Ohl <br /> PLACER TRACTOR SERVICE <br /> NON-HAZARDOUS M T - <br /> GENERATOR NAME NOR CAL BEVERAGE GENERATING LOCATION <br /> ADDRESS _ _1080 E. FRFLL, " <br /> CiTY,-STATE & ZIP PHONE # 2n9_94' ma I __' <br /> "CONTAINERS: NO. VOLU WEIGHT I <br /> 'TYPE: TANK TRUCK DUMP TRUC DRUMS OTHER k <br /> PET.CUNT.SAIL L <br /> WASTE DESCRIPTION: GENERATING PROCESS <br /> ppGG <br /> DESCRIPTION OF WASTE' QUANTTIY : `TYPE <br /> W 2• <br /> d <br /> PROPERTIES: PH SOLI bgbID SLUDGE SLURRY .OTHER <br /> HANDLING INSTRUCTIONS: ` <br /> THE GENERATOR CERTIFIES THAT THE WASTE AS DESCRIBED IS 1000/o NON-HAZARDOUS AS <br /> DEFINED BY 40 CFR PART 261 OR ANY APPLICABLE STATE LAW, AND HAS BEEN PROPERLY f <br /> DESCRIBED. CLASSIFIED AND PACKAGED AND IS IN PROPER CONDITION FOR TRANSPORTA- <br /> TION <br /> RANSPORTATION ACCORDING TO APPLICABLE REGULATION <br /> Typed ar Printed Ful arae and Signature Date <br /> 4 <br /> NAME - - .PLACER TRACTOR SERVICE TRUCK # <br /> ADDRESS P.O. BOX 170 ' .DRIVER NAME <br /> Cny, STATE & ZIP LOOMIS CA. 95650 SERVICE ORDER # <br /> PHONE <br /> �Aw' <br /> Typed or Printed Full Name and n ure Date <br /> HULSEY LANDFILL 916-383-2122 <br /> DISPOSAL FACILITY PHONE # F <br /> $597 JACKSON ROAD <br /> 2 ADDRESS DISPOSAL METHOD <br /> :. <br /> O <br /> CITY, STATE & ZIP _SACRAMENTO,CA. 95825 SACRAMENTO,CA. 95825 � LANDFILL OTHER <br /> Z `. t <br /> A Typed or Printed Full Name and Signature Date { <br /> DISCREPANCY: <br /> , �` . ,� <br />