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r � NAS REC <br /> ORD ' t <br /> _ <br /> WXk <br /> its wittb+f�fr o <br /> p2owg O WASTE (M2®t be filled 6#-produce " HAt1LIIt Or WASTE (Must be filled by hauler) <br /> I 01h .ar t, a <br /> LA I <br /> `(,Llai( sr yps)r o �•� , n ,. - . _ <br /> a p�siwesa I,dcress: tro t icy <br /> ,1Nsssss t ` .-, teea <br /> 11Ck A treat y ialbphone Pkmbar. p Tom' <br /> 2slapbsns <br /> Ameba ri .0-t- <br /> O. or Contract Ho.• <br /> tau. Liquid Waats Hacicr'c Pt9!"rati;. <br /> ,: <br /> leder Placed Sys _ y Crfc tic. <br /> ' <br /> Type of Procasa t <br /> welch Produced uestes; <br /> tf <br /> el eE oil drti .ng--C o. til?,itLs, vacua :z•_ s <br /> ,. <br /> it <br /> Esamp s: meta plat , equipment- _ _ . . <br /> wastewater treatment, pickling bath, petroleum rainiitt) +.c t ;c d: 4yeaaa <br /> The deacri ! vase was haul; : .y r C <br /> . ., L•sC;r En.j mAi � - <br /> DfSCR?PTIOy OF BASTE (Must be filled by producer) E:pity r�r �f <br /> of perjury that the =c:egll;`3 i e <br /> Check tgpe of wastes; baton sediment and Gcrrect. <br /> 1, Q A s^Ivtien Ss Q gra" ra o mut .or: ar. • <br /> 9 r., <br /> : <br /> Dtil= _t <br /> Q d <br /> sr .t !ascii + n =l r+stedke gait i�aa ex l <br /> 4. Paint'a.udst int �. <br /> 22. 0 Cannery vasty __ �pr � .;, <br /> 5. D Solvent <br /> a, C letrsec!.yi lead siudss 33. 3Latex wrest® <br /> g :e AdC.-c ..- _ <br /> CChem. �l tu:tai m►atss _ lw. tt.d aad .atxr g <br /> 15. U Priaa '-y and <br /> s _ 3�1CVe �e lYB Y�el tats ' <br /> •. _ - c --s t ksiX•9 r .i ,ms+r.ts S.r._a <br /> !!y) it yrs an.accep_a <br /> prtMeatt'of iiasith :e +iia*.lona ,,,� .cab cestil .s:ons. <br /> Como �ez,t•n -rrtre'i on.e <br /> phenolics, aelnents fl:sti, Motel& (lint), E i <br /> oraarles (list), o}aaida) g=e4verq <br /> �f <br /> (ap}city) lo. <br /> i (slap es+ <br /> _ <br /> .. <br /> 2 � 3iapossl (agEcify)• Dexui �spr'sa�t:a� <br /> 2f �sata is '410 $od <br /> ` Li <br /> # Dlaposal Dat <br /> I certify <br /> ®f pee)us: <br /> ford .ares urdr- '-" <br /> r} that the <br /> 6, and ca ret_ . r^7- -^��" ark t t e <br /> Naa•rdous Ptepertis*A lisatt: e <br /> � , g_ ,� t. -a to tbs <br /> c•e tRwic flaaaa�Dla eerrvaise "` s:glasivc � "*. _. _ <br /> pH ® - The site operator ana:l a..":. <br /> +� <br /> -` �_ gal r^nm barrel• otha* State Department of Fealth rite ac;nthly fee reporta. <br /> k <br /> Containers; other <br /> IMahar, drum cartons 11bega <br /> Pbystcal States nsolid []liquid ®siudse ❑®nom= p <br /> Spaeial Noodling lostrwerions tit anY), <br /> 177 7 7.7 <br /> wast• is desestbed t• the beat of my ability and it was delivered to OR O.H= I�!!tB'R EXCIm <br /> s'.". <br /> caessd_Iiquid waste hauler cif app! •►. YAM OR Of= MATERIALS CALL ( +) 434 <br /> FOR_r r�aK �'1_ LS t�ot�►1 <br /> Aft"t <br /> ry for d•clar•l ia4�r pGAalty <br /> s.mf j%eriury.that the forepoinq is true <br />