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HAZARDOUS WASTE HAULING RECORD AND CERTIFICATE OF DESTRUCTION 065301 <br /> %Ito% I INTEGRATED ENVIRONMENTAL SYSTEMS SUBSIDIARY OF NORCAL SOLID WASTE SYSTEMS,INC. <br /> —:� 429 High Street,Oakland,CA 94601 <br /> X (415)2614512 <br /> is.261.,��. <br /> GENERATOR OF WASTE: <br /> = <br /> F WASTE: <br /> NAME TR.ACY US WASTE <br /> (PRINT OR TYPE) 0 CONFIDENTIAL WASTE <br /> PICKUP ADDRESS 1-R A f..."Y, 0A 0 OTHER <br /> CLIENT REFERENCE NO. <br /> The waste is described to the best of my ability and it was delivered to the <br /> M ::DI:f-.,AL licensed waste hauler described herein. <br /> Xcelo are)under penalty of perjury that the foregoing is true and correct. <br /> HAULER OF WASTE(Must be filled by Hauler): r 0 'u� <br /> INTEGRATED ENVIRONMENTAL SYSTEMS <br /> S <br /> io <br /> tur u oze <br /> 499 High Street,,Oakland,CA 94601 Sig tur, of authorized agent and title Date <br /> '00'* (415)261-1512 DISPOSER OF WASTE(Must be filled by Disposer): <br /> O/EPA 10# CAD 980890321 ❑INTEGRATED ENVIRONMENTAL SYSTEMS <br /> HAZARDOUS WASTE 499 High Street,Oakland,CA 94601 <br /> 2028 <br /> HAULERS REG.NUMBER: (4151251.1512 <br /> D OTHER HAULER'S REG.NO.: The hauler above delivered the described waste to this disposal facility <br /> TYPE VEHICLE: ENCLOSED VAN and as described it was an acceptable material under the terms of the <br /> DEUVERED State Department of Health regulations. <br /> NUMBER OF BARRELS: — =— <br /> &' Quantity measured at site <br /> NUMBER OF BOXES- <br /> PICK UP: ?�e HANDLING METHOD(S): INCINERATION <br /> 15ATE TIME DRIVER <br /> disposal The described waste was hauled by me to h l e ispo. facility nimed below DISPOSAL DATE: <br /> and w accepted. <br /> Qx <br /> WAA 9V <br /> title Date <br /> Signature of aur Date Signature of authorized agent and ad agent and title GENERATION OF WASTE <br />