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r <br /> CCI <br /> Gib on <br /> nvironmental <br /> Non--Hazardous Waste Hata Form <br />' EPA ID No. Fill I III IIIIJ <br />' zName a-K-ELLSPhone <br /> Mailing Address ,- a-D k -7 *S <br /> 6 Generating Slte z- s �11 41b,11"z2 02 5 a,'Wt Z . -Ftj 02 <br /> Waste A Uq4�� d Soil <br /> Estimated Volume I f 5 ss A TONS/YDS <br /> Waste Description: <br />' p Components of the Waste PPM �'X J S Compw4nts of the Waste PPM % <br /> LI)A L E t2- vS <br />' v Special Handling Instructions D Gloves 0 Goggles 0 Other <br /> `" enerator ce 77 that the Wpste as owribed 1s IMK nC rdout <br /> Slgmtur f Authorized Agent Ito <br /> Name e 'AEPA ID No <br /> Address 4 Zsv ti Phone Ga -- 44.E - o <br /> Truck Unit ID 1124- / I �aArL /2- <br /> Pick Up Date 1 Z <br /> rz <br /> � Order No. <br /> Sign6tdre J Date <br /> Facility ,17 9- <br /> ❑ CAD980883177 ❑ CAD981458466 9CAD043260702 <br /> U Glbson Environmental Gibson Environmental Gibson Environmental <br /> End of Commercial Dr. 401 Canal Avenue 475 Seaport Blvd , <br /> Bakersfield, CA 93308 Wilmington, CA 90748 Redwood City, CA 94063 <br /> (805) 327-0413 (310) 549-9117 (415) 368-5511 <br /> (3 Disposal th Release * L ,5"I 11 Actual Tons/ al s -S <br /> Sl nature pate <br /> A SubWlary d V LS..Inc <br /> 3300 Tnotun Avenue Suite 200 • Bakertfleld CA 93301 • 805/327-0413 • 800/852-3935 a Fax 805/861-0229 <br /> WMO&-G�Goer V Geroralw • Pht Traticofti . Go0egroo-Gerwrcar Beton Coot <br />