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06/02/2005 10:25 FAX 510 614 8396 PARADISO MECHANICAL liholo <br /> NON-HAZARDOUS WASTE DATA FORM <br /> NAME <br /> ADDRESS <br /> T"m Tforn7_7AAA <br /> CITY,STATE.ZIP PHONE NO. <br /> cc <br /> 0 CONTAINERS:No, I VOLUME WEIGHT <br /> TANK E] DUMP <br /> LL' ri TYPE; - 0 DRUMS <br /> CARTONS ❑ OTHER <br /> z TRUCK TRUCK <br /> UJI <br /> 0 WASTE DESCRIPTION 2" S GENERATING PROCESS <br /> >- COMPONENTS OF WASTE PPM % COMPONENTS OF WASTE PPM <br /> 2, 6. <br /> CL <br /> 2 3. 7. <br /> 0 <br /> 0 <br /> LLI 4. <br /> go <br /> 0 PROPERTIES; PH ED SOLID ❑ LIQUID El SLUDGE El SLURRY 12 OTHER <br /> HANDLING INSTRUCTIONS! <br /> ON �f7llkLF 1"IC <br /> /* T(lZ <br /> TYPED OR PRINTED k:CNAME&MNATURE DATE <br /> NAME <br /> LLI <br /> Til 7jj <br /> IE ADDRESS SERVICE ORDER NO. <br /> 0 <br /> CL <br /> W CITY,STATE,ZIP PICK UP DATE <br /> z <br /> JE PHONE NO. <br /> TRUCK,UNIT.I-D-NO. I[-.)t!f: -; TYPED OR PRINTED FULL NAME&SIGNATURE DATE <br /> NAME <br /> 7i DISPOSAL METHOD <br /> ADDRESS ❑ LANDFILL 11 OTHER <br /> CITY,STATE,ZIP <br /> PHONE NO, <br /> TYPED OR PRINTED FULL NAME&SIGNATURE, DATE <br /> GEN OLD/NEW L A TONS <br /> TRANS s 13 <br /> CO RTICD HVVDF NONE DISCREPANCY <br /> TRANSPORTER'$COPY <br />