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NON-HAZARDOUS WASTE DATA FORM <br /> r'UIOr Spot CO. <br /> EPA <br /> 5100 E Harney Laner,o �P1,Al 1 `fy_1`� I J I <br /> ADDRESS <br /> CITY.STATE.ZIP <br /> radl. California 94320 PAONaNO 09,333-0233 <br /> j <br /> CONTAINERS:No, VOLUME 1�A A'i (--- WEIGHT <br /> F. to TANK a DUMP <br /> Z TYPE: ❑ TRUCK }4p ❑ DRUMS C1 CARTONS ❑ OTHER <br /> THUC% <br /> „ <br /> C <br /> I <br /> ul <br /> Soil with diesel <br /> iHc 1:100 ® Tank Remora! <br /> S <br /> DESCRIPTION <br /> PP GENERATING PROCESS <br /> WASTE 6£SCR .. <br /> COMPONENTS OF WASTE PPM COMPONENTS OF WASTE <br /> soil <br /> JDiesel 100 is a <br /> o. <br /> 1 7 <br /> C7 <br /> in a <br /> O: 1 PROPERnE&: g)"- qfOLID ❑ LIQUID ❑ SLUDGE ❑ SLURRY ❑ OTHER <br /> _ 1 <br /> J Approval =120189-288 <br /> HANDLING INSTUCTIONS: <br /> 4 THE GENERATOR CERTIFIES THAT - <br /> ¢ THE WASTE AS DESCRIBED IS 100% <br /> -.r NONHAZARDOUS. - ,�'2✓U►vTY K, wW0►vticirI,.� i. l ••,.i•I 1': <br /> j I - TYPED OR PRINTED FULL NAME A SIGNATURE GATE - <br /> �I I <br /> EP <br /> Dillard Trucking. <br /> A C A a 9 g 1 5 :) ^_ 3 i) :I <br /> N' 1 I I I I <br /> j .NAME <br /> tU <br /> �.. -�ROL4Le L BOX 4-3 SERVICC ORDER NO. . <br /> ADDRESS <br /> a Byron. California 94341 <br /> -PICK UP GATE <br /> W <br /> r { CITY.STATE ZIP -'T <br /> PHONE NO. [ilJi.l�3'i'036i , 1% �j,• <br /> TRUCK UNIT.I.D.NO. TYPED OP PRINTED FULL NAME 8 SIGNATURE GATE <br /> EPA <br /> Liquid Waste ?lanage>kent. inc. No CI AI D n l8 .0 i s 16 ,a1 f <br /> NAME ., - <br /> OISPO5AL METHOD <br /> Zi. - <br /> - I.— <br /> ADDRESS Star Route BOX 4 - ® LANDFILL ❑ OTHER <br /> a} ".Kckittrick. Ca.:0325! <br /> } V CITY,STATE ZIP _ - <br /> _ ----__ __ <br /> PHONE NO. r305 aa�.^1366 - <br /> _s .. - <br /> ht ' - • r-� TYPED OR PRINTED FULL NAME A SIGNATURE GATE. <br /> GEN - OLD/NEW L A TONS . <br /> `#4 - TRANS - -.S B _ <br /> C113 - - - RTlCD - -. NTYDF NdNE - DISCREPANCY- <br /> r. <br /> MINE FIE 1111 <br /> k .r <br /> , <br />