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orr•-� R � �j � ANiF sr "_-� r r �vasteJS �#d�� eneret N e; b`Ge eraL ;dn RL y, 32 I ' _ d Addre s Mi no No Sri. �� S f Phone No.: ' N/ er of the ge n t sl'I fefsfro 1'p orator;provide: - f el's Name. .. Y h. Owner's Phone No.: v R WASTE �, i.. v 1p - 7 7 V �� .Containers TYPE DM-METAL DRUM 10 11 -. DP -PLASTIC DRUM Description of Waste: t_�=1 \ �5 'sak L k. Ouantit - Units - NN�o. TYPE BA -6 MIL PLASTIC BAG _ W � or WRAP .\.�JJI�� T T -TRUCK O -OTHER .;GENERATOR'S CERTIFICATION: I hereby certify that the above named material is not 5 hazardous waste asdefined by 40 CFA Part 261 or - . UNITS ''any applicable state:faw, has-been property described,classified and packaged,and Is in proper condition.forfiansportadon according to I P -POUNDS :Applicable regulations AND,If the waste Is a treatment Id of a.previo ly stdcted hazardous waste subject to the land Disposal Y -YARDS - HesMctians,I certify and warrant that the waste hss a in mcordan the requirements of 46 CFR Part 268 and Is no longer a M' -CUBIC METERS tlfazardous waste as denelln��ed by 40 CFR Part 261. t _ ?'k '' Ys--CUBIC YARDS >k s'kNS�r'fT'\#tom+ IO1\.\.AQD - O -OTHER enc or Authorized Agent Name - - n r hipment Date TmnsporterIcompletee-g - 7 i TI ' S..,,< '`-•ryt' ,�_-'` NSPORTER {Generator complete a-d; Trans orterA core tete fi n J. R T TRANSPORTERII . Name: - 1 In. Name: - J. Address: . . _i._Address: Driver NamB' e.�- -J.-Driver Name/Title: - . Pia E ! - MNT(rYPE . Phone No.: ,e. Truck No.: ( k Phone No.: I. Truck No.: Vehicle.Uoense No./State: G- m.Vehicle License No./State: A=.gement of a eipt of Materials. Acknowledgement of Receipt of Materials. n. - nature Shi ant Dal Driver Sl nature Shipment Date i2CflOn III -� , •''' (� 4 DECS-TI'NATJON ;(Genemtorcompletesaid+ esunationsdeemmpletesef) .` . Site Name: V Pao t` NPSN TVAI?.+ Lwy t l,t-, c. Ph on O.:. r"5 ' y — `-'� lt 4�\ N. It o �oN� A N . �lt�� AD . Physical Address: d. Mailing Address 'WM . Discrepancy Indication Space: - i hereby certify that the above named material has been accepted and to the best of my knowledge the foregoing is true and accurate.