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NO. U2738 <br /> NON-HAZARDOUS WASTE DATA FORM <br /> Generata�a Site Address{I1 dlfferanithan mailing address) <br /> Generasar's Narne and Mailing Address VALERO `S.J'TATi O N f�'3641 <br /> VALERO C LIFO�'NIA RF--1'��1L CCS 1 C!F Tf�f�! 1210 F.HAMMER L.N. <br /> eab vvEnT`rHIRE)9TRF-'EME STOCKTON.CA X0210 <br /> HAV-0RD, CPE <br /> Generator's Phone!.6- -° Container type transported to receiving factNty: <br /> Container type removed from site: ❑ Dump Truck <br /> ❑ Vacuum Truck ❑ Roil off Truck ❑ Dump Truck <br /> ❑ DrumsX)lP Vacuum Truck ❑ Roll-Off Truck <br /> proms <br /> ❑ Other <br /> ❑ Other <br /> E_ y Quantity Volume l <br /> OQuantity (J"" <br /> LLr n. GENERATING PROCESS 4� �- <br /> t]i WASTE DESCRIPTION_ �IaN H1�!f P ' ITER` COMPONENTS OF WASTE PPM % <br /> PPM y^ <br /> Z COMPONENTS OF WASTE <br /> LU <br /> 0 1, WATIR �3l3�1E)�3rlu 3. - <br /> 2. TPH 3 A. <br /> WaSte profile PROPEFITIES: PH 7mjj)- ❑ SOLID A LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> TH <br /> HANDLING INSTRUCTIONS: t� <br /> Generator Printed/TypedNams Signature Month Day Year <br /> I_srr t3 t hzsd of BF9 On behalf p?gerLi rcitorF <br /> The Generatorcertdies that the waste as described is 100%non-hazardous <br /> Transporter 1 Company Name Phone# <br /> CC BELSKREI Q40-4196-5200 <br /> i,jJ Transporter <br /> I Printedlryped Name Signature Month pay Year <br /> Ph ii <br /> aTranaporterAckn edgment of Receipt of Materfafs <br /> (n Traneparter 2 Cblhpany Name - Phone# <br /> Z NIE T O &SONS TRUCKING, INC. 7144610.0855 <br /> Transporter 2 Printedrlypad Name Signature f/l/ Month Day Year <br /> Transporter Acknowledgment of Receipt of Mata6ws 'f <br /> ` Designated Paoliity Name and Site Address Phone# <br /> DE:°MENNO KERDOON 310-537-7 100 <br /> V <br /> 2000 N.At.AMEDA S7. <br /> <Q COIy=PTON, CA 00222 <br /> 0 <br /> Z <br /> LLI Printedfryped Name Sign re Month Day Year <br /> SK InInti ` �. {CC . <br /> Designated Faclliry Owner or Operator:Certifleation of receipt of materia Icovered by thl da a form. <br /> r <br />