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No. <br /> NON-HAZARDOUS WASTE DATA FORM <br /> BES1 0 <br /> Generator's Name and Malflng Address Generator's Silo Address(Jif different Dion mallfig address) <br /> 1tt: N.M -- AN <br /> GIO .'�*4f;R i",Ufa 11'e CONTROL 80P.R0 I�11_0 1-1 ._I <br /> � <br /> (,ENTRAt.V/41C-�RU-61)N 4 04()EAST MAIN GTP�EG.T <br /> 1141?.!)'UN CENTER DRIVE,SWIT4 2100 <br /> RANCHO GORCM&CA fW570 SiTOCKTON.CA 06215 <br /> Gen <br /> Container type removed from site: Container type transported to receiving facility: <br /> ❑ Drums ❑ Vacuum Truck Roll-off Truck ❑ Dump Truck ❑ Drums U Vacuum Truck P Roll-off Truck Q Dump Truck <br /> ❑ Other ❑ Other <br /> CC Quantity Quantity 1 Volume <br /> 0 <br /> WASTE DESCRIPTION N100-1 "".011- GENERATING PROCESS NIONIT ORING t.L.PESTM ICTION <br /> LU <br /> z COMPONENTS OF WASTE PPM COMPONENTS OF WASTE Prim % <br /> LU <br /> 0 10 0 3, <br /> 2. 4. <br /> Waste Profile 1.3 - 311 PROPERTIES: pH U SOLJo Q UOUIO Q SLUDGE C3 SLURRY U OTHER <br /> HANDLING INSTRUCTIONS: WEAR ALL APPROPRIATE.PEW-30NAL PROTEC"FIVE (J..,J I'l IINC;. <br /> Generator Printed/typed Name Signature Month Day Year <br /> I ;Irry Nloothart W RED on bc�hqlf of pr-irmrzitor I ZA 1 <br /> The Genetato(ceFlifies that the waste as described Is 100%non-hazardous <br /> Transporter I Company Name Phone# <br /> cc <br /> Uj Transporter I Printed/Typed Name Signature Month Day Year <br /> cc <br /> Transporter AcknaMedgment of Rece!pt of Materials <br /> Transporter Company Name Phone# <br /> z <br /> Transporter 2 Printed/Typed flarnis Signature Month Day Year <br /> Transporter Acknowledgment of Recelpt of Materials <br /> Designated FacUrty Name and Site Address Phorwo <br /> PC)TRt-.H0 1-111,1S I ',N0FJLI_ T07AA'!A027 <br /> .",,',37jF POTIRIER0 H11.1.G I.ANK7. <br /> `3li.115LIN CITY, CA 946.8:5 <br /> LL <br /> 0 <br /> Z <br /> > <br /> ED Fir-Intedrryped Name SignatureTh I YOU <br /> z. <br /> LLJ <br /> Cr Designated Fac;14y OA nor or Operator;CQ(tJf4etlo1f0f?eoef'Pt ma!ada!s co-wed by this date form. <br />