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( HAZARDOUS WASTE HAULING RECORD AND CERTIFICATE OF DESTRUCTION <br /> „a 065302 <br /> ❑ � "i- INTEGRATED ENVIRONMENTAL SYSTEMS SUBSIDIARY OF NORCAL SOLID WASTE SYSTEMS,INC. <br /> x Y-— 499 High Street,Oakland,CA 94601 <br /> (415)261-1512 <br /> GENERATOR OF WASTE: DESC TION OF WASTE: <br /> 7 <br /> NAME '"fAi-'Y (::;`-;ti`w'AL.. ::`: r' ::I•�? ilCar�l_: BIO-HAZARDOUS WASTE <br /> (PRINT DR TYPE) <br /> PICKUP ADDRESS 'r!.r' }�� =<' I s)""1-�F' fly Y P! n(.:f 0 CONFIDENTIAL WASTE <br /> CLIENT REFERENCE NO. 0 OTHER <br /> The waste is described to the best of my ability and it was delivered to the <br /> licensed waste hauler described herein. <br /> HAULER OF WASTE(Must be filled by Hauler): ert' (or declare)under penaft of perjury that the foregoing is true and correct. <br /> INTEGRATED ENVIRONMENTAL SYSTEMS <br /> 499 High Street,_261.1512 Oat CA <br /> 94601 <br /> (415) Sig ature of author agent-and title Date <br /> DISPOSER OF WASTE(Must be filled by Disposer): <br /> EPA 10#CAD 980890321 <br /> HAZARDOUS WASTE ❑INTEGRATED ENVIRONMENTAL SYSTEMS <br /> HAULERS REG.NUMBER: 2028 499 High Street,Oakland,CA 94601 <br /> (415)261.1512 <br /> ❑ OTHER HAULER'S REG.NO.: <br /> 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 /> PI - DEL .g State Department of Health regulations. <br /> NUMBER OF BARRELS: <br /> NUMBER O BOX S: Quantity measured at site .p <br /> PICK UP: --„ INCINERATION <br /> HANDLING METHOD(S): <br /> DATE TI E DRIVER <br /> The ' d waste was hauled m e isposal facil' arced below DISPOSAL DATE: N <br /> and as a epted. —y_ <br /> zy <br /> Signature of aut rzad agdWt-andtitle Date Signature of authorized agent and title Date <br /> GENERATION OF WASTE R� <br /> 4 <br />