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i <br />' WASTE 1U9E 1QN <br /> Attach separate page(s) for additional waste material(s) . <br /> r Material Description: <br /> I <br /> Process Generatin <br /> g th s waste: (be spgcific) <br /> 5 • 77 <br /> Accumulation Date: _ I2,/7 /7y <br /> Type of container: DrumsHow many Type <br /> Bins How many Size <br /> Bulk' pile A6-- Size 00 y)-(Cy) <br /> Other <br /> If drums, what are the drum numbers? <br />' Any special requirements for um pick up? (Rusty, missing <br /> parts, leakers, etc. ) <br />' If tanks and ri.nsate, please indicate the number and size <br /> of <br /> tanks and what thlast contained: <br /> I <br /> Comments: -- <br /> a1Z1191 -1-V 7-7 ZE41 <br /> Form filled out by: ____ Date: <br /> Phone: 6G 7Fax: 79- 8�- 7$3 0 <br /> z <br /> I 1 <br />