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i <br /> —06- <br /> 0c j <br /> Gibson <br /> Environmental <br /> Non-Hazardous Waste Data Form <br /> EPA ID No. \ <br /> o4� <br /> -� <br /> a Name , .�� �. z2 <br /> z <br /> Malting Address ` �' 2 d s"Z <br /> Lu Generating Site <br /> Waste: ❑ Liquid ❑ Soil <br /> LU <br /> Estimated Volume BBLS/GALS TONS/YD'S <br /> Waste Description: <br /> co p Components of the Waste PPM % Components of the Waste PPM 96 <br /> W <br /> h <br /> L <br /> k � <br /> O.. 1 <br /> uSpecial Handling instructions ❑ Gloves ❑ Goggles ❑ Other <br /> m G a if�ss-t�q <br /> r c rtt the w ste as described Is 100% non-hazardous. <br /> r <br /> Signature of AuthorAd Agent Date <br /> Name EPA ID Nor n o S <br /> Lu Address -�� L�Q1.t-� Phone �� a <br /> Truck Unit ID <br /> a. Pick Up Date <br /> Z Order No. <br /> Signature Date <br /> Facility <br /> �_ ❑ CAD980883177 ❑ CAD981458466 ❑ CAD043260702 <br /> Gibson Environmental Gibson Environmental Gibson Environmental <br /> u End ofCommercial Dr. 401 Canal Avenue 475 Seaport Blvd'. <br /> Z Bakersfield, CA 93308 Wilmington, CA 90748 Redwood City, CA 94063 <br /> O (805) 327-0413 (310) 549-9117 (415) 368-5511 . <br /> cn . <br /> m_ <br /> O Disposal Method: cycle Release # Actual Tons/Gals <br /> Signature Date <br /> A Subsidiary of V.L.S., Inc. <br /> 3300 Truxtun Avenue,Suite 200 • Bakersfield, CA 93301 • 8051327-0413 • 8001852-3935 • Fax 805/861-0229 <br /> White-Glbson Copy * Yellow-Gibson Returns to Generator . Pink-Transporter • Goldenrod-Generator Retains copy <br />