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NON-HAZARDOUS WASTE DATA FORM <br /> SniiT1?I PND CORPO ;,TI4p1 _ <br /> MAINE <br /> EPA <br /> ADDRESS POST OFF-TCL "O?: "04 <br /> 1D110 17CID1912 1 416161 !!j 0121 <br /> CITY.STATE.ZIP ' ,'.�0 C eL'i't y r-(, ; <br /> PHONE NO f 9 4 6?—.'i 1,1 <br /> Q <br /> I Q CONTAINERS-No VOLUME WEIGHT <br /> j4 <br /> TANK <br /> 1 � <br /> W ❑ TRUCK ti DUMP <br /> TYPE: ❑ <br /> _ <br /> Z TRUCK ❑ DRUMS ❑ CARTONS ❑ OTHER <br /> W <br />.j WASTE DESCRIPTION �%,t:CLYN`. CONTI!MIi'ATFT.� SOJL LA13r <br /> i GENERATING PROCESS <br /> m COMPONENTS OF WASTE PPM X, COMPONENTS OF WASTE PPMui <br /> v6 <br /> 12 <br /> LY <br /> I.} a z ttT'I42ri��' i7 6 k <br /> p3 TOLUT,P!ZE 4 <br />' 0 <br /> PROPERTIES: PH '- SOLID Cl LIOUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> HANDLING INSTUCTIONS: <br /> THE GENERATOR CERTIFIES THAT I <br /> THE WASTE DESCRIBED IS 14086 <br /> NON-HAZARDOUS.US. <br /> TYPED OR PRINTED FULL NAME'&SIGNATURE DATE <br /> EPA <br /> Q NAME Dwight Trucking, Inc. Ho C A D 9 0 0 6 9 I 7 2 S <br /> W <br /> Q ADDRESS P.O. Box 81675 SERVICE ORDER NO <br /> CL <br /> U) CITY.STATE_ZIP Bak emfieK Cakifornia 9=0 PICK UP DATE <br /> Z �' _\ <br /> a 8� M / <br /> cc PHONE NO. (B05)39918787 7 <br /> ! /L f ' �![>r{moi <br /> TRUCK,UNIT,1D-NO. C f G TYPED OR PRINTED FULL NAME 5 SIINATURe - DATE <br /> EPA <br /> NAME '. rP -.Z �m� �r•i .n^�-r• I.D. r T1 C• <br /> NO. <br /> _,1 7.r z�%i T !-C'l f DISPOSAL ME <br /> ADDRESS ❑ ANDFILL OTHER -( <br /> V G7Y.STATE.21P <br /> ti /1 .42 71Ih -Dt,1,Y� Q <br /> PHONE NO. <br /> � ,.i�Z,2f1.•. � , ,�—kyr-.- - -- __.. <br /> k3*P OR PRINTED FULL NAME S SIGNATURE '—� ! DATE <br /> GEN OLD/NEW L A TONS <br /> TRANS <br /> C/O RT/CD HVVDF NONE DISCREPANCY <br />