Laserfiche WebLink
- zovaNnM, s <br /> NON-HAZARDOUS WAS <br /> DATA FORM3410 <br /> F I•'1 NAMF 'OiOr Spat CO, EPA I semiI�s,. nn�� <br /> 5400 E Harney Lane No. I `+ •I '��LE Il jE N P T I i <br /> 71 ADDRESS <br /> Lodi. California 945 0 PHONENO. 12Do 1333^D29S - <br /> t _ CITY,STATE,ZIP,__ A - <br /> f YJ <br /> O GONTARiERS:Na S voLuses wElaHr <br /> cc <br /> 11,64K DUMP <br /> TYPE: ❑ TL.JCK :-�TRUCK ❑ DRUMS ❑ CANTONS ❑ OTHER . <br /> Z Soil with diesel <br /> t. �'•'� (5 1.100-ppa GENERATING PROCESS Tek Removal` <br /> 3. WASTE DESCRIPTION <br /> s m - GPAM ^6 COMPONENTS OF WASTE - PPfJ <br /> OMPONENTSOF WASTE 4 <br /> f W f Soil 99% -- <br /> ltJ Diesel 1.100 1% <br /> t _ T. <br /> 3 - <br /> - <br /> m a __ <br /> POoERTIE& FH IU © LIGUIo © SwoaE 0 sLl1RR1 ❑ OTHER <br /> R <br /> L .# ravel 9120189-285 <br /> LHANDLING INSTUCTION <br /> - T - THE GENERATIM CERTIFIES THAT - - <br /> - THE WASTE AS DESCRIBED IS 100%1 } - 11 ^� <br /> :.: aaj_ <br /> IT <br /> NON•HAZAnnous. - - ,JQfG►yt;� rYl l+r-rf <br /> TYPED OR PRINTED FULL NAME 6 SIU4TURE : - DATE <br /> r �► r 4 9289 <br /> Dillard TruckinW. Inc. D a D 9 8 i <br /> Ta ,._. NAME <br /> ii(i4bb'wrr+;;;f Route-1�AOx 13 - SER1110E ORDER <br /> ADDRESS._. - <br /> c ' <br /> a Byron. CP.iifOrnia 94544 <br /> CITY.STAT£.ZIP PICKUP DATE <br /> .. . <br /> ' PHoP1E NO, 1415034-0567 <br /> Typal <br /> D Ql1 <br /> - - TYPEDO PRINTED FULL NAME StG A1VRE-� OA'I'E <br /> •RUCK UNIT.10.NO. <br /> .. - <br /> EPA - <br /> Liquid Waste H:,aagement. Inc. <br /> NAME <br /> NO. <br /> SAL METHOD - <br /> - ---------- ---- -- -- ---- ------- - -- <br /> DISPO <br /> I - ApbRE93 S. rRoute B01C- - ---- ------ --- ® LANDFILL ..❑ OTHER <br /> 11 <br /> 1 y HcKittrlck.. Ca. 33251 - <br /> i CITY,STATE.ZIP;'' - - <br /> PHONE NM <br /> 805 T02-'r386 <br /> t <br /> TYPED OR PRINTED FULL NAMZ l SIGNATURE OATS - <br /> J I <br /> -•.`_..J GEN OLOINEW L- A TONE - <br /> Ij .. TRANS S <br /> .c. <br /> 1", r'. � .� 010- RT/CD N1NOF NONE 015CREPANCY _ <br /> t <br /> ± �F <br />