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4 rT <br /> NON=HAZARDOUS WASTE DATA FORM !} <br /> NAME S0UTEIT TAT L CCRPORATTON <br />_K EPA <br /> ADDRESS POS'!' O.?:'FCF BOX 404 Lo C :'1 D 1 9 ° 1 1 1 41 r I (A 1! I f-,E��I <br /> �. <br /> Q <br /> CITY.STATE.ZIP 1)117''',S -``TOI-:, CALTt-10P?N17, n,,5 r,e <br /> PHONE NO fC161 G61_2?7 ; <br /> 0 CONTAINERS:No VOLUME - 5_ WEIGHT <br /> 4 <br /> .cr <br /> Lu TANK Dump <br /> Z TYPE: ❑ TRUCK ® TRUCK ❑, DRUMS ❑ CARTONS ❑ OTHER <br /> W ' <br /> V' G:ASOLi N"I" C.O.�.•TA!;IT'!ATX:,'D SO]L GENERATING PROCESS I=NX I E J <br /> WASTE DESCRIPTION <br /> .m COMPONENTS OF WASTE PPM 4b COMPONENTS OF WASTE PPM % <br /> W 1. J.'ifi 270 <br /> 5— <br /> BENZENE <br /> CL <br /> 0 <br /> v <br /> W 4 <br /> m <br /> O _ <br /> r PROPERTIES: DH L—! ❑SOLID ❑ LIOUID ❑ SLUDGE ..,❑ SLURRY ❑ OTHER <br /> 1f <br /> HANDLING INSTUCTION$ <br /> THE GENERATOR CERTIFIES THAT �J f �� <br /> THE WASTE AS DESCRIBED IS 100% � �j Z <br /> MON-HAZARDOUS: �� <br /> TYPED dR PRINTED FULL NAME&SIGNATURE DTE �! <br /> £PA <br /> Dwight Trucking,Inc. .D C A D S 8 0 6 9 8 7 4 3 <br /> W NAT NO. _ l 11 -1 --L--1-_i_1 - 1 1 1- <br /> OADDRESS P.O.Box 81675 SERVICE ORDER NO <br /> ZCITY.STATE.ZIP Bak emfteldL CaMornia 953M PICK UP DATE <br /> C / <br /> PHONE NO. (805)3".1877 <br /> TRUCK UNIT,LD.NO- -7 U�{Od�/�"�OHS PED OR PRINTED FULL NAME E SIGNATURE DATE <br /> EPA <br />{� NAME _r' _�% Ih1?.�.'.`??'•�.;.;v',c ,.. .__ .�� 'No. C. ;`� S• & �) r ° <br /> f DISPOSAL METHOD w <br /> I <br /> I r ADDRESS -� ci '013i% ❑ LANDFILL OTHER <br /> V Cm.STATE.zIP 4Cx I I'-�'�:i C ri C z T 3'' C�''_ 7:? 9 2 S i <br /> QPHONE NO. <br /> W OR PRINTED FULL NAME AT J I, I DATE <br /> GEN OLDINEW I L A - TONS - <br /> TRANS S B <br /> CIO - RTICD HWDF NONE DISCREPANCY ,�, <br />