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71F - <br /> j ,J9 <br /> Gibson <br /> Environmental <br /> Non-Hazardous Waste Data Form <br /> °C EPA ID No, <br /> Name �— � PhoneZL51 <br /> Z Mailing Address -- <br /> Lu Generating Slte L�CZ-- <br /> Uj Waste: ❑ Liquid ❑ Soil <br /> Estimated Volume BBLS/GALS TONS/YDS <br /> Waste Description: <br /> in Components of the Waste PPM % Components of the Waste PPM % <br /> uj <br /> 0-- <br /> w <br /> i a <br /> O Speclal Handling Instructions ❑ Gloves ❑ Goggles ❑ Other <br /> U <br /> LU r for rt' ' the w/oste as described Is 100% non-hazardous. <br /> Signature of Authorl d Agent Date <br /> Name �-� 5 CEPA ID No. <br /> be <br /> d ress .a.�. one <br /> 'Truck Unit ID \ <br /> N Pick Up Date U -,?D - <br /> zQ Order No, <br /> `�-- <br /> Signature Date <br /> 4 <br /> Facility <br /> CAD980883177 0 CAD981458466 ❑ CAD043260702 <br /> V Gibson Environmental Gibson Environmental Gibson Environmental <br /> End ofCommerciol Dr. 401 Canal Avenue 475 Seaport Blvd. <br /> Z Bakersfield, CA 93308 Wilmington, CA 90748 Redwood City, CA 94063 <br /> Q (805) 327-0413 (310) 549-9117 (415) 368-5511 --7 f <br /> m <br /> CD Disposal Method: le Release # Actual Tons/Gals <br /> C.. o �i <br /> Si nature Date <br /> .A Subsidiary of V.L..S., Inc. <br /> 3300 Truxtun Avenue,Suite 200 • Bakersfield, CA 93301 • 805/327-0413 • 800/852-3935 • Fox 805/861-0229 <br /> White-Gibson Copy • Yellow-Gibson Returns to Generator • Pink-Transporter • Goldenrod-Generator Retains Copy <br />