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MAY-19-2001 (SRT) 23: 45 P. 003/003
<br /> FROM FRX NO.
<br /> rJuF. 28 2803 11
<br /> :29Am P2
<br /> ''i ••, '4' :I'�,I. ! ''w i. l iJr•�.1�" .r ,I.' ,• KN.I• „r•.�K,:. �". ,. '. a i•
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<br /> 't'i l:^i.""'"'L...ni}--t•" •' L...`C",. rs.q
<br /> w �—,,. } .��,—�.w I ,•,. •^' .:u.` i ...4 nF.ylri..�.--r.R.;'..,•,�..•.NL.:;.r.,��.I�� C•••� 9:'�"
<br /> ' .':liji,.w� .•'R'J°�w�»««. w w w.Fji Fav I•, "`.7i.... ��I,�"; ........Yj'.. ",�^G....
<br /> ..,(. w+Mr,t.s,yi.,�•kl.�Y'¢t'�c'wil�Mr,n r�.�r .t'.'M�_ ��� � 5-��'wl w y�.F�� K�"' 1��"
<br /> •1 "I. a ..Y- ..�......N•Iw"+,.«. .i1...,.iwJ.-.:r.N•ed....wir«� ..�.rK"f»�»»•�� �',*`'ti'f".C.
<br /> TU ,BE -COMPLETED, $Y;:WASTE'-.HAUTt -,-BEFQRE�'•ENTRY.To SRWCF • -5150
<br /> i' , p1.8tiR8PR)Nf!1MYP1tI31p431�13t1f',�dCo ()k$.C=�LgFOLtIwwaLxcrrssAcaEpHD. •'t ,
<br /> Nasrtw,'$aculor r'
<br /> p"y. arae '
<br /> y 9ehiclQ capacitor ,.�10:00
<br /> " 'vehicle Licence'No. ate' J /,• Load
<br /> t, 1tey;,
<br /> C.oapa.wtwr''n."m delre>,:sr• tYPbi':aad' titiy �,sourca.(s) •below.. A'sigpr tture, -shall- ba
<br /> obtained•Erna zrepreaontativs from each VjAk fpiag•the type, 'imd'gM=tity meted
<br /> •�.• �f':rwro.Chan':f sources hn"the:Jeaate:'1-oadp ;attach. additi osial, £orl�., Bandon,variiir-ati>aa .
<br /> will be''ande bq,;SRlICP.. ,
<br /> 2 .
<br /> '�,;/t. •�ed'drg�e: '"1: �., Addreoaa" ,
<br /> Pbogo Ido.-.�'., ' '� • 'Phone No.-('; } '
<br /> ;'�•
<br /> :'Waste'Tyke: Quant.Lty r •Type_
<br /> sigienttur - �f' SigMatur
<br /> Y,•Z�ate: Time: k.MY H. Date:.�.Time: ti • yn8. .M.
<br /> Within et ckt:o city limits? 'youa Nithin:St ckto city- 2iat`itis? Yea o
<br /> '4. :Hattie: j
<br /> address:
<br /> «; Zip. " zip.
<br /> „i'lionliii.po;r(• ., �, , , I Phone No:'•
<br /> Waste hType; quantity: qal. Waoto Type: " -''" QuAntity:; 4al.
<br /> :Signatgza: Sigatuso: .. _
<br /> nate: Time: ;�i:M' 'P:rl. Data: Timo: 2L JC P.H.
<br /> Within%stdekto'n 'CLty:zq m4 to?: Yen* No, Within: Stockton city, '1'.imits? Yell No'.,
<br /> TOTAL QTr'(117.1 Sources):'•
<br /> r '
<br /> AXIawablo Wf Lzte Typo: Flacs':'aigpl.£cabIa np aber.in space,provided abovi.
<br /> ''�'»; „•1.:.Rrvaidentinl';sepxago: 2..'kertabld.'ToUme' 3. 2toatalirant Grease Intorccptdx '4. Special•
<br /> '•Dis2st;sge- . • ' '
<br /> AW�hzm JW01cot ba eoqui*but &O'be
<br /> �A'9p ddrmane[becam d,od.gWriW R,WSRWCRbdad& t "
<br /> I;'the below framed waste>'haulcr.,''d'ecl:are' nndcr.pcnaltjr,of perjury, that-to the beat of
<br /> my
<br /> i"iodgst Z have,ac'** dtel y'deacribed the-typo,;'quantity,. and aourco'of .L11,wastes v4hicit'I'
<br /> now 'regsicat-to 'di epcae of at, 'tip' SRWCP I''further declare, under, penAlty of "per jury;: 'that
<br /> T 'was�paraonallX•informed by *the•owne owner's agent, or•occupanto of•the •property.where
<br /> 'th,i n,'waat6 'was,re6e!Lvgd'&r have ' +o7Caoaal .knawlQdgo, that this Wiat4 contatao only
<br /> ras�dcatial; septagc •or grease, -or•'in 'tha 'cacao of a special.P.ermit, is-not hazardodo,and
<br /> down* not. axcood yarea ttiottail►'•nut os£xvd limits -as per pretreatment/Source'control
<br /> requirements, I also• declare`, under.penalty,of perjury, .that the tri,ck(a) used,,to" i
<br /> trinuport thie3 Kaat'e wa4'tree. of all•matexi>31® 'characterized bylaw 'aa a .haza>:dous waste
<br /> ' or substance"at'the timo.of,arald•.unci I ars aware of tho 'condit£oae and',regULr'amenta of
<br /> .. .the; Waste'Basler•Percait� xsez'
<br /> • Fuz-t , I' undcratand ihAt failure -to accurately dcaciibo' then.�;.��•:
<br /> abova -izformation ox"fiifure:•to•-comply'with my,Vadtd adtd Hauler' Permit and/or•,aay' applicable„�:�,�-
<br /> &tWCF magulatipn,•,may'.rcault';Ln the •immediate auapcnaion of my Wamte Hauletz:. pes�alt
<br /> other`.gon&Itieo:,aa' may beal
<br /> ' lowed, by law. and f v .,:
<br /> Walvio FRaaier s 'gdat„rc
<br /> .. CFU'1n is MWIN45(2M 4664=*
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