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<br /> C .1 NIA LIQUID T �_�� z�
<br /> r 14'5
<br /> ; �i?ATE WA'�t i� CES �YRfl .,
<br /> STATE DEPARTMENT Of HEAi.j'1i
<br /> 1ULEROF WASTE ( at be filled
<br /> ER OF WASTE ()fust be filled by producer
<br /> �
<br /> wasm
<br /> (print or tyla)t
<br /> 7Cde No
<br /> �. , :3usines -�dCcs&s: 1
<br /> aLa tr:tt
<br /> Pick up AbdrebYs Citjtraet tY. ?itA ;tp. / e Tine: P4 \i
<br /> P.O. or Contract 'note
<br /> Nq,• "e eon ne Ahxrsl�r
<br /> Toler-hone Number: � � "
<br /> ROte:- takts Ligvf`'Z :abYe Tla�.'4x' e lea b rat'c,. Nc, fit a:;-1LteC+le):
<br /> order Placed Ur
<br /> it
<br /> a"s Tziyn:_....,,��,,,, -. --
<br /> Type of P.;,ceaa
<br /> • / m
<br /> LT "* ii i t
<br /> ic1 :uiu<.°cE rlsatea; - �*a,u,
<br /> gat n r ui seaL cleanin oil d ili,nie� ode tea. xG1 i t zy
<br /> Examples: cera p- g, $.
<br /> t33
<br /> s-estevater trestm+ert, pickling bath, petroleum refining') "h+� #6brined r, ste was le lt, 'e to k" N B aa.
<br /> i'lrscp.T,YNO OF WASTE (Must 0 fillei b4 proc,,cer) fy
<br /> +_-q
<br /> Cbeek :{
<br /> '7e of ,castes: of pssury t ai me £o>e aixta.. t� lank t+.,MYaa 'ser3 izue ist az13 a"L. t. c7^atUte0 "lle3irs sosvtio�, Cil
<br /> :
<br /> 1 n � ;V. Off' WA t E E� _ f}. 3 3, xA_ pc}Ser)
<br /> �. .� Pesticides 10. �;Ccn$ : ,q le,... Aft
<br /> s a <1> Cctartinated $ttii cad<eend
<br /> 5. 0 4,1�ent 12, D CancarY waster
<br /> .may - < " Latex 4aste
<br /> L.d
<br /> f., �<es�t�eT ;oad a.°.cogs 1". tJ
<br /> 1 0 • � Pn,d snJ w&=Uar :-s. .1d,ita,+.e� ...
<br /> l�. s�
<br /> ma
<br /> dEf: SCC L_s'5'ti C=. .c: A �: t_-rm t
<br /> r 8l
<br /> Ot—
<br /> (specify) � uzl� Via. e}f 1:_Alth e�" 4;lcsiv. allo <.cal ra.,i, aaa
<br /> c _•. ,
<br /> gbe oi.cm, t P.t a, ,, tabz as 6oA rfc.
<br /> or-ga.it-s {list),
<br /> a
<br /> M
<br /> Ltia
<br /> a eB: 17
<br /> .+4: rev $ Pg r
<br /> epeci£y,1 j&VY**d!,1iisrd�9 scam is
<br /> �i rocs
<br /> i
<br /> j ue :a .geld rox g�sFc�.a:
<br /> LD
<br /> ,....+.. ,e.,.»......,....,,,..+....�_......_.,..m.-�..••..-.,..,.,_.y+s..._...�,.._ro,..v.:-...,. �: .A....} 's :£a r-3.> ,C 1" d a l a z t) ti^'dt!
<br /> s %
<br /> 'a. i$
<br /> sxards Pxc,ncrt.es a .Fs
<br /> c ¢` e
<br /> (£i a V :,.ris. i3 `.'3eerrosivs exr2ceS s
<br /> aTe sits »rot spa `.a 6 `e copy � �. p�.
<br /> ,,, 4 3 .�.—� t the,
<br /> gal ,.mss ba "ls r�taar Seatehcepaartment of ti#a.-tq ,.1 2�2nthiy tee reports.
<br /> d; a iaYT
<br /> r drums f itartwxx gaga i. _dotF�as x
<br /> isf8 1 -t
<br /> Pbys£csl State,% `�s,-Aid [Tiqui sludge 0other ,r,.._..m x.
<br /> special Rsndling lnstructit�,* ,if anyi4,,
<br /> i waste is dsscrib to the beat of my at.IItty and it was deliver to
<br /> a liconaed liquid waste hauler (ii appl e'+. 'T ffi spGacin Li
<br /> 'tIr Iexti'ty for declare) under �nalty ;� � . ' LS '
<br /> bf o,rjury thal the foregoing is rue
<br /> ";r
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