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t. m <br /> s <br /> Waste <br /> N��N-I-iP.7._�1RDO�S SPEG��L WASTE MANErES-T <br /> systems rl., <br /> ilii( ldllltlG F <br /> Ennis IIJOU 3TiIErS a 7 y r .L <br /> +.. • , _ C=,enemling Location _-- <br /> Generator Name <br /> .Address <br /> _r� --_— -- _--- ---__—_—..— Phone No. �1 T1 l .- <br /> Phone No. �__._I _��-_.�.__�...�__�- _ __ _ - _- <br /> I r CPI1taSIkF.�'i TYI'0 <br /> ,. _ ---SI -TS ff 1I Il I fI 1I` D-Drum <br /> �_._� ___ t „ —I pu lntit U-its N_ i5'- <br /> _ <br /> BFl Waste, Code -- - - Y-- --- 1 — C_ ar an <br /> C,escriplioll of Wasta __ - — - -- <br /> �_L_l � <br /> -- — — — - i r r, Bay <br /> - 1. <br /> --- � •Truck <br /> i'C 1 <br /> -Pounds <br /> Y.YanJs <br /> 0.011101 <br /> able <br /> q y 4,1 CFR Part 260,10 o Y PP <br /> lic <br /> licab!e sate jaw, has been properly described, <br /> 1 he,ebl'certify that the above Warned material does not C0111 air, Tree liquid as defined b <br /> stato lane, is not a hazardous vaaste as delined by 40 CPf3 Part 261 or any apP jicable tegulalions. <br /> ejassilied and-m—okaged,and is in proper condition for transportation according to app <br /> ' 1 r <br /> Ge, t-r'o,Hullr J r1g_nl ilnne <br /> ,ilr . _ i ft�wY?....'c�y�,.,',•.wr 'x-wk`.°•eC? i_�-' ,��4� + <br /> '.'r.T' '•9t.•,�9 .w. <br /> d'.'.'I N-tSH�'�;•,,,.,.•.}tel.tl.•.r9_u::=ter <br /> Phone No. <br /> Tuck No._•-- - " —_�— — t <br /> t Driver Name(Print) -*— <br /> Transparlef Name <br /> Vehicle License NO./State <br /> Address <br /> !;•- " r`i Vehicle Certification �— <br /> Y lf+e above Lamed material was picked up 1 hereby certify that the above named material was delivered with- <br /> I hereby certify that out incident to the destination listed below. <br /> al the generator site listed above. } <br /> �`~� L �Y�� �-•�_._���-� '..._-.�___--. -� Qflinnry Llate + <br /> Dila Diivrs$ignatWa <br /> Un nr Sign'nr re <br /> -."+wYlrT'r""5 �tOl\[rtr�'� t `__ +1 _ ,�,Fryn t_-•. � rr•. r <br /> •'9 t t' '_la Il.isef SL..�_".k �.-.- ••2':"xi.+�-L"r'r_ ..ra <br /> 4r., <br /> �M tea.: : El 1II <br /> Phan <br /> o 140. <br /> Site Name <br /> ,'lddfess —_------ <br /> _...._ A my knowledyA the foregoing Is true and accurate. _....__ <br /> I hereby certify that the above named material has been accepted and to the es <br /> Signature <br /> Aull,arrzed Aden[ <br /> PASS CPOC <br /> nnzco-nP <br /> s0rei <br />