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t <br /> _ + 04. 00 <br /> Gibson <br /> Environmental <br /> "11 100 <br /> REM <br /> Non-Hazardous Waste Data Form <br /> o <br /> \ BPA ID No, 1 0 <br /> Q Name c.. Phon <br /> Mailing Address <br /> Lu Generating Site s;- <br /> Uj Waste: ❑ Liquid ,\ S <br /> Estimated Volume BBLS/GALS {y ON DS <br /> m Waste Description: <br /> I� 0 Components of the Waste PPM % Components of the Waste PPM % <br /> W <br /> I.- <br /> w <br /> 1 <br /> CL <br /> p Special Handling Instructions ❑ Gloves 0 Goggles ❑ Other <br /> -, <br /> mGe wo r thews as described Is 100% non-hazardous. <br /> O <br /> Signature of Author ed Agent Date <br /> Name EPA ID No. g <br /> LUdr ss �� L �= hone <br /> O v Truck Unit ID Z <br /> Z <br /> a; Pick Up Date <br /> Z Order No, <br /> Q <br /> oc <br /> Sign re Date <br /> Facility <br /> CAD980883177 ❑ CAD981458466 0 CAD043260702 - <br /> {j Gibson Environmental Gibson Environmental Gibson„Environmental <br /> 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 /> m_ <br /> O Dispos Method: R le Relegses# Actual Tons/ Is <br /> Si nature Date <br /> A Subsidiary of V.i_:S., inc. <br /> 3300 Truxtun Avenue,Suite 200 • Bakersfield,CA 93301 • 805/327-0413 800/852-3935 Fax 805/861-0229 <br /> S <br /> White-Gibson Copy + Yellow-Gibson Peturnsto Generator • Pink transporter • Goldenro6Generator Retains Copy <br /> 4 <br />