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Gib on <br /> nvironmental o � <br /> Vt M <br /> Non--Hazardous Waste Data Form <br /> j <br /> EPA ID NO. <br /> Name �?�ti�L Si 7r� _ �,l�2�c T Phone 715 <br /> W Mailing Address 0-Fso k S-7 4-s i-zr �014+ CA (')'V5 3-7 <br /> Cz Generating Site dti o 4o , '7S '71F, z- _ <br /> Waste -a UML&I © Soil <br /> Estimated Volume L J 68 GALS TONS/YDS <br />■ >2 Waste Descrlptlon: <br />■ o Components of the Waste PPM T► compor>onts of the Wasto PPM % <br /> USpecial Handling Instructions Q Gloves 0 Goggles O Other <br /> m Generator Certifies that the wgsts as disc vd 6 IML noM=rdous <br /> SlgnatureN of Authorized Agent Date <br /> NameEPA ID NO <br /> Address Phone <br /> 2 =�r�-c C 'a c2*s -3 Truck Unit ID I I z4- <br />�' 4A .:_ _ .-Pick Up Date ci 1'� �� <br /> Z Order No. <br /> 2� <br /> Slgnat ria , J Date <br /> ae <br /> Faclllty G CF_ S-0 <br />' ❑ CAD980883177 Qi CAD981458466 CAD043260702 <br /> r j Gibson 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 /> ( !DIs:peo , od. ecycle Release # ISq I Actual Tons/Gals /6y <br /> ` <br /> S nature Date <br /> A SubIdbry d V Ls.inc <br /> 330.7 Trt.mtun Avenue Suns 207 . BOkersffeid, CA 93301 a 8M/327-0413 a SM/852-3935 a Fax 806/861-0229 <br /> W'0*4t n Co,pv • yfkNp-( D' uurr 10 Gersrmw . Pr*Tmrdooftr . :0iMV004er*nVM Petory Cody <br />