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NON-HAZARDOUS WASTE DATA FORM <br /> Jj NAME 0v - EPA <br /> TADDRESS WA— Ja 4is� NO. I <br /> ai <br />` CITY,STATE,ZIP �. PHONE NO. I <br /> s. <br /> `O CONTAINERS:No, _ VOLUMES C WEIGHT <br /> cc OUMP i <br /> l Z TYPE: ❑ TRUCK TRUCK ❑ DRUMS ElCARTONS ❑ OTHER <br /> WASTE DESCRIPTION 1ff111 4Et NERATING PROCESS <br /> COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM <br /> W , 5. <br /> l J s. <br /> CL 2. <br /> ul <br /> 4 In 4 <br /> OPROPERTIES: PH OaD ❑ LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> j HANDLING INSTUCTIONS: <br /> i <br /> THE GENERATOR CERTIFIES THAT er <br /> THE WASTE AS DESCRIBED IS 100% <br /> NON-HAZARDOUS.. �1� C`, ....JJ" — <br /> r <br /> TYPED OR PRINTED FULL NAME&SIGNATURE <br /> t / EPA <br /> NAME �7 !4- !-•I I.D. <br /> NO. <br /> LLI <br /> f ADDRESS __ SERVICE ORDER NO. <br /> I a t .- <br /> N CITY,STATE,ZIP PICK UP DATE v <br /> Z <br /> F PHONE NO. 1 l <br /> TRUCK,UNIT,LO.Nt7- TYPED OP PRINTED FULL NAME 8 SIGNATURE DATt <br /> EPA <br /> NAME ' b;o! NO.MU <br /> DISPOSAL METHOD <br /> ADDRESS ® LANDFILL ❑ OTHER <br /> i J <br /> j U CITY,STATE.ZIP <br /> ILL <br /> Q PHONE NO. <br /> —a <br /> TYPED OR PRINTED FULL NAME$SIGNATURE DATE <br /> j GEN OLDINEW L A TONS <br /> TRANS S <br /> Cl0 FIT/Co HWDF NONE. DISCREPANCY <br /> •i ...�..e-• ,s.. . - <br /> iJr .. _ r ,f, ...,. y.�.ml. � >J�:....�...o;;.�„ai.ka ams,'ssic,.srA..:Aar.�..,�„�T_a;•a•,i4L�r.ti.a...i.,�r.�•,'di.:a�.+....wwi-_�.:x�.,�..o- �.s..,c.�vi <br />