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I <br /> 1 <br /> No' 4$Ea2.93 <br /> { r t <br /> ru - ous SPECIAL WAS�t-E iJ�/1NIF�S7' <br /> Was � <br /> systems " NON-HAZARD 4. <br /> VIIII <br /> nnnwlnlrr,.rr:nnis urouetnfr-s h » :pl c - . <br /> to 9"F&MM <br /> r�'110intiltig <br /> - <br /> r,anerntor ttama ___�----- i 1 - • Arlrlfos�-- ---- �._ - <br /> } <br /> !'-Ili tkl:r,e,, C:a, J•14U7. �� �.�..�-� — [� _" _ -j-- . <br /> - --- 1 6J ti-� T'Ifone ado. ------- <br /> .. <br /> -_l _���? - Coc,inirinrs U•l]rui„ <br /> F <br /> Y- <br /> pliol,n Ifo. } [ �_1aual--., <br /> � � }� j Ouanlily_ Uni1s NO'__�l,YL0 _Cnrron <br /> L U C <br /> tElill Wn!:lo GO&' DesGriptiori of W�,l=._� — ---- ! tt—...i1= � _3.. I T .t ruck <br /> lti,l, ihl'y'Lru,u Eiull tourlC4 ( �' Y.Yards <br /> �r..,,;.tttc'r, c•r utt�tcty 4 <br /> GLUt:�r3n_ t.unit � } <br /> 0.0111ar <br /> or any npVk--bin <br /> nU C>ft h, <br /> _ rfJ erl described, <br /> — ��,t 26t os any applicable 5taly law, tins been p p y <br /> I ISOreby rerlilY,hal rho ahovri�r.arnod n,olortul dons Rol cnninin lreo fiquld nsg olin�r111C ble reyulal'sans. <br /> ro r condition lar lransportalion acGordift to a p i <br /> sli4se lavr, is nit a hazardol�i5 Iltlp �pn afin di by 40 Cf T1 t` `I ��11J � <br /> a �/ - o <br /> classified and packaged.` Ikl�/ <br /> � �{ S,riprnen,Unto WHOM=I <br /> Yom- M l <br /> rrn..,nt�!',a11ir,,irod hg � <br /> 4.15-634-5t15 <br /> Phony No.�-- <br /> 1 ruck No._.-----f��-'� <br /> flriver Name(Print) <br /> Tfanspo,ter Name <br /> !)i11Ft:ci 'Ttuci:i+:rl� Xt� 1�' _�- 1-• _—�--•1 <br /> "Vehicle Llcensv No.1Say <br /> Mx <br /> pdd,ess Vehicle Cofcation <br /> 1']rcllt, Calil`o[ni1 ! <br /> ---- I flefeby cerlily Il+al Ilia above(tamed ral was deiivefed with- <br /> ' picked up <br /> I hereby cerlily that the above Warned material was P <br /> out incident to the destination listed below. <br /> led above. <br /> at the generalcr sitet! Mirp <br /> Ur,llvnry Unln <br /> .f gl,Iprnard Rata <br /> ON 73 <br /> leMwl <br /> i <br /> prion- r 5�9'taSusn K'� e <br /> Srt til�r4—IL <br /> (tion©till <br /> Nat L t <br /> site t'laflle 1,icc[r:rlre, l=�• N550 <br /> ---�'- <br /> 41101 1k111�t �]cw,lU Ira+r Address—-'----- d and to Ilio best 01 my knowledyv llie!oregoing is true and accurate. <br /> ;lif that lha above named material ties been accepte <br /> hereby Cey nocet,Uale <br /> 51 naiula �. <br /> -- <br /> �~ PA55 COUP a{12G0420 <br /> '°°f TRANSPORTER RETAIN <br />