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<br /> ORD
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<br /> i r 1975 c
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<br /> _ STAtE'•pVA it£ 15 CifNTit<1L°A�S�lttt? - s• �v ,� -
<br /> STATE DEPARTMEPiT Of HEAL.T
<br /> OF BASTE (!lust be filled,b5 producer
<br /> HAULER OF WASTE (. at be filled bar rauler )
<br /> PRODUCER 4 (ptr,t or cSpp}: C .
<br /> (priet or typo)x 'i,:,d* '40.
<br /> s. 3uaicas:a �.a;
<br /> Pick up Addnss: �}y� .g Saba tccat Cit7r ^y tam
<br /> 4L ME I
<br /> St,
<br /> SY Talaptxs;e Nusa at "i 3 l'1.> -p. %/ Xis: pe
<br /> Telephone Naber: P.Gs ^t Contras ?vg,- '®" 7^9.
<br /> .�
<br /> Data; `. _ C $tats 1.^;�•_�d k�at� Hs,ee s r,e�fatrats. kn `Sf ica.,.e)s -
<br /> ftdar Placed 9v: c
<br /> r a
<br /> .',•pe of PrGt.ess
<br /> ehieh `trodueea! 'gaseas; jvt r w :a}s< s
<br /> Examples: aSa plat aqui se*, l an na, oil dr;llir,g�--.lt iro> Yehic$e- +>
<br /> vase€water trsatm.enC p:ck::r.$ be raH:,i:cg
<br /> T�z detctiiaati wage' aiaa }�?aae*� � t".r= u- uoaai
<br /> OF WAS-Tt (Must be � F-�9 tr; producers
<br /> .. .
<br /> Of ;�:.3 L:'1• that
<br /> Check t re of atea: correct., a er>
<br /> l; ® !ct�i. � 1uti_„9 d, ?onk buttc� aadime:,c and :firs ure o all aq
<br /> x .7 as soh:°;c
<br /> oil
<br /> w _ - 1
<br /> Q rills#� 0 tj Sts 'Jr WASTE
<br /> {
<br /> �, -Q ,mat rises
<br /> 4, nr a'.vdg-: _1. - Ca �oa a.
<br /> truted soil'aad CoQ”
<br /> .,
<br /> i2, i,arrary waste z (g ¢
<br /> S. � 5 ve,E +
<br /> a T ae. a ar13, Latex vsrta , 1
<br /> v y "Isras 16, i `sem ani
<br /> .1. ® BTina
<br /> " V%e hay or Zed atc, t,,tys
<br /> o '.k .. x ..
<br /> Qtha «pacify) o.' an mac « an
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<br /> rc ,sc s' tto, 1 eoTiosiv x !seise .
<br /> �.. _ The sere vper� , ,a a,.a kub� a ?�� �;s, » y �
<br /> �( r� x uat4th w;, A,,>nth fee reports.
<br /> 3�
<br /> t?aaiLer r�, ;dates treses Libslga Liot erg.
<br /> mhg-rica3ttcssan,?iQ A,,, iq:,.G ,�ttudda oit ci' pr,,,,„,,,,,,�„ir•s� -
<br /> g._,
<br /> Spe
<br /> tial N_oaccling Instruct,.-,
<br /> :e at to is described to the beat ,fmy &.ility and it was delivered to
<br /> i licensed liquid .sesta hamar (1f xgpl ei. FOR Sit .�`'+Ra ,pl
<br /> 1` certify for declare) tindsr Qeraaity N 7+A (�30 `
<br /> tit por u t bat the 'fore+going is
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<br /> � ry• ..,
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