AR0160 ^ y > _ : AJUZONA HAZAPDOUS VIASTE MANIFEST - ^ NIFEST ^ U^j^) /

Princ or Cype a l l informacion on Chis fonn \ SFUND RECORDS CTR

\ 0222-90728

I . PRODUCER QF WASTE (MisC be f i l l ed out by Producer) SFUND RECORDS CTR

NAME S/ie/ / OA^ CZO . 88016455 PICK UP ADDRESS t 'O7 yU< -TSX^ A ^ g A / i c e ~ S ' j r o C j :

Nonber Screec Cicy Zip

TELEPHONE NO. : ^ ' ? 2 - < ^ f ? ( ADHS FaciliCy # NM • . "(if applicable)

TYPE QF PROCESS ^ ^ ^ ' ^ ^ ^ ^ ^"^ ' ' ^ ^^-^^^^" ^ , . , VmCH PRCDUCED V STE J e T SIC # i A / / f

DESCRIPTICN OF I'iASTE (musc be f i l l e i cur by Producer) Ch.eck type of wasCe:

. 1. acid solucicn ^ 8 . tank boccan'-sedimeic 2. alkaline solucicn 9. o i l 3. pesCicides 10. drill ing mud 4, painc sludge 11. ccnCaminaeed soil 7 sand 5. solveiC 12. cannery wasces 6. Cecraechyl lead sludge 13. laCex wasce 7. chjenical to i le t waste 14. mud and water

Oth^r (specify) 15. brine

CCMPCNENTS: OXICENIRATION (Bcanples: Hydrcchloric acid, lime, caustic scda solveits upper lower 7<, ppn ( l i s t s ) , metals ( l i s t s ) ) .

1. JMAre/: g.ri 2. .s-/] i / P 3 -?• ^ \ ' S 7

6. HA2ASDCaS"TED^J^nS"^nSsTEr / '^7n7s^^~7^:^. pH Ncne "^ Tcxic. Flamrable corrosive ejqjlosive Bulkvolune ^y^ gal. S^D*?Cons barrels^ ocher_^

(42 gal) (specify) Ccncainers druns careens bags oChjer . ^ L ' J ^ K

(mTnber) ^ (specify) Physical State: solid liquid ' sludge 6^^ocr.er

(specify) SPECIAL HAIIDLEC DSTRUCIICNS (If any)

I certify that the abcve irsste is accjrately descriced

DATE l - l ~ l ^ ~ l ' } SIG'A-JRZ A\ - ^^• C£(/--/•:'-/^f 9 0 0 0 1 ? 5 / ( • / / C \ . / ' . . / '

' / \ l I " l / ' ' ' ^'', • ' ' M'j^ruu.L-x.i.ji Ur cJi-- J—i..). .ji—^^ x.^u.^ [liuil ^ f /HA- l ', . _2, Bureau of Sanitation.

. ' 411 ro. 24th Street Ptoenix Telephone Nunber 255-1160

c. ADHS APPROVAL DISPOSAL AI: (SiCe)_jr\ 'HC^(i^CyUl-yy^.f>'<

(Area of sice) / rtk: i

y ^ ^ ^ ^ ^ APPROVED BY: y<JC{Afl'(C7^/ / [ n . - d i . ' ^

D^: K/l)rC(?im^Hy/

A A *> A A A A'*V

I . HAULER OF WASTE C ^ C be m i e d ouc by Hauler)

m/E /A /yj A'' /^-//A^^^/^ (^r/€/^y2x:K-BUSINESS ADDRESS . ^ r y i / . ^ ^ ^ y ^ . / A ^ /^Ay>t^y^^/>L r P ^ O ' 7 3

Nunber " Streee Ciey Zip TELEEHCNE mJ^^-AvD<>. PIGC UP _ _ ^ _ ^ _ TIME _am pn

JOB NO. NO. OF I O A X S / T R 5 ? ^ 2 _ _ - VEHICLE UC. :?,2JLLz/aZ/ \'EHICLE: Vcrjun Truck j y ^ Flatbed _ _ _ _ _ _ Other _ _ _ _ ^ _ _ , _ _ ^ _ _ _

XsD^IEA) Thja described waste was hauled by ce to th£ disposal f a c i l i t y named belcw and was accepted.

I CERTIFY: IHAT IHE FOREGODC IS TRL'E AJD

Signature of a u t h o ^ i z ^ ageic and c i c l e

CV. HAZAPJQUS WASTE FACILITY (M^SC be f i l l e d in by Fac i l i ty )

.. , SHE ADDRESS yyyfT,r^y>.yyf)^p-tr^ ^'yyyor-/^^ ' ^ 7 AEHS PERMIT NO. N/A • ' .QUANTTIY MEASURED AT SHE (If applicable)

The above-named h.auler delivered tb£ described waste to t h i s f a c i l i t y and was accepted t h i s date .

: :Ay^At.<><^A/, , . , /-y-^-A/f :; :.; Signaturjs^'or aut.'r>ri2ea agent and t i t l e Date

. • • , ' f . • • •

DDmCMAL CC^2'E^7IS:

AJUZONA HAZARDOUS WASTE MAinPEST MANTFEST Q Q H J ^

Pr in t or type a l l informacicn on th i s form !;;i^

I . PRODUCER QF WASTE 0 ^ ^ be f i l l ed ouc by Producer)

NAME G h ^ / f O / C ^ C O .

PICK UP ADDRESS \ 0 7 A^- S^^'-il!, A / ^ A/,o<^' ^ S ^ o C . 3 r • Nonber Streec Cicy Zip .. ', .''..-

TELEPHONE NO. 2 1 7 - 2 Q J \ ADHS Fac i l i ty / ^/A ( i f applicable)

TYPE QF PROCESS S'TT/f/Ii^e t^/^'ic S i -^PS-B" _ .:,. VKLCH PRCDUCED WASTE - T E T A SIC # <A / / / .•;-•• ;

DESCRIPTICN OF VS 5IE (cmsC be f i l l e d cur by Prcducer) . "Check t3,^e of wasCe: _ ,.- '..,•.

. 1. acid solueicn J<; 8. Cank boCtan"*sedimeie 2. a lkal ine solucicn 9. o i l :,;..; 3 . pesCicides ^ 10. d r i l l i ng mud 4. painc sliidge 11. ccntaninated soi l 7 sand 5. solveic 12. cannery ;.ssces 6. te t rae thyl lead sltidge 13. la tex waste 7. chemical t o i l e t waste 14, mud ard water

Othjer (specify) 15. brir.e

CCMPONEiTS: CaNCH^HRAJniON (Examples: Hydrcchlcr ic ac id , lime, caustic scda solvents upper Irr.v-er 7. ppn ( l i s c s ) , metals ( l i s t s ) ) . •

1. li/Hre^ g r -2. C H .w/r^ .3" 3 . A?,'-},i~ ( l - t ^ : i C ' J ) ^ -4 . v\-.- <-- { c:-ir t r cL-ij.. ) y ,-

6. RAZARECUS PROPERTIZS CF VASl'E: /'e< 0£.<^Lr7TT~. pH Ncne-^Tcxic Flarmable corrosive explosive Bulk volune i ^ gal.^ot^ tens barrels^ other_^

(42 gal) (specify) Ccntainers druns cartons bags othier f^^'^/C

(nunber) y (specify) Fnysicai State: solid liquid sludge ^^ other

(specif/) SPECIAL HAJ XLEC DISTRUCIICMS (If any)

I cert i fy that the abcve waste i s accurately described.

DATE \A--iX- T/ Sirs^C^ / ^ ^ ( A J A ^ A C J ^ ' 800012G . - - P f -r- C \ /^ .JL.

-2- Bureau cf Sanitaticn 411 No. 24th Screet Fnoeni'T Telephone Number 255-1160

n . ADHS APPROVAL DISPOSAL AT: (S i t e ) -MA^^OO^' -^X^-^ .^ /^^

'(>,(-1 A ' (Area of sice) A J i f- / I I ii , ^ I 1 1 I I .

APPROVED BY: <>4/(. 'I/.. I C T ^ O K 0. O ^ DEPARl^iENr OP KEALIH SERVIGF.S

DATE:

kkkkkkkk

': /^hoOrn(a<:>. ^ 9

XE. HAULER OF WASTE ( i ^ t be f i l l e d out by Hauler) NAME A/A yz&A// P e T / W e a ^ Oyirr/pr^cfoj^ BUSINESS ADDRESS / p ^ ' A A - D ^ 5 ' Y l ^ /^^^^ ,/^^;g/i//V ^ ^ d ^ ^

Nunber SCreee "^ CLcy oj TELEPHONE ND.P^f ~ < ^ / ^ ^ PICK UP ___^__^__ TIME an pn JOB NO. NO. OF LOADS/TRIPS^^^^^ VEHCLE U C . -:? 5-../- -A J / VEHICLE: Vacuun Truck \ A ^ FlaCbed Other _ The described waste was hauled by ce to the disposal facility named belcw and was accepted.

I CERTIEY THAT THE FOREGOING IS TRLTl-A © COR2B$J/7 ^ A .^

A iAAA,< A Sii^nature of autrorized ag^t—ar.d t i t l e

A A A 4^t'\ 4\ «v'A

!:V. HAZARJOUS WASTE FACILITY C ^ t be f n i e d i n by F a c i l i t y )

;;;:•': SIIE ADDRESS x^;^^/cf^^/^/i .^^.v/;,^/^^ ^ y AEHS PERMTT NO. N/A

;.::', QUANTnY MEASURED AT SITE (If applicable) " • ..- The above-named hauler delivered the described waste to this facility and was ;.; .accepted this date. -. •

•;::U:-;.;::^:SignaeLrg^ Date • ' f \ • ' . ' • ' ' • ' • ' : - ' • : •* : } . ' y z . ' - ' • : ' • ^ — ^ ^ • ' '. " *"

OinCMAL CC^ME 7TS:

ARIZCNA HAZARDCUS WASTE MANIFEST MANIFEST jt [ J H T - U :

Princ or Cype a l l informacion on t h i s form i . . ' . ' • : . . . . »

I . PRODUCER QF WASTE (Misc be f i l l e d cue by Producer) • -^rl^:;;:

NAME S l ^ ^ t A OAC- C O ' . : PICK UP ADDRESS / O ? A^ ^ ^ ^ d \ / / / e . A/tO(^ ^ i T O Q ^

Nonber Streec, Cicy Zip

TELZPHC^ NO. '^y.yj '^f j I ADHS Facilicy . ^M v;x;; (if applicable)

TfPE QF PROCESS ^ ro,Z/iOe lAiAh 5 ^ 4 t ^ ^ e WHICH PRCDUCED VIASTE T c T- A SIC ^ 72 7 / / .. ;

DESCRIPTICN OF ViASTE (raise be f i l l e i cur by Producer) ''..'i AAAh-Check Cype of wasce: .;::':•,;;;:•:'-•:-.

. 1. acid solucion . iX S* tank boctan sedimenc ."; : ; . ' 2. alkaline solucicn •, • 9. o i l '.: 'v. ;-.:;" . ;. 3. pesCicides .. 10. dril l ing mud . -'iV'''^':'. A 4. painc sludge 11. . ccncaninaced soil 7 sand •r'p,:; 5. solveic 12. cannery wasces 6. Cecraechyl l e ad sludge 13 . laCex ^vasCe 7. chjenical CoileC wasce . 14. mud and waCer

15. brine Ocher (specify) • .

CCMPCNQTTS: CONCENTRAITON (Bcamples: Hydrcchloric ac id , lime, causcic soda solveiCs upper locker % ppn (lisCs), metals ( l i s t s ) ) .

1. c{/ATe./c ^ j s _ -2 . y^i .1^^ y 3 . /•' c' s r

\ ' h - ' "•'' - X L -J • •

6. " ^ - "* HA.ZARta;S PROPERTIES OF WASTE: eAnjF^-,J~~^t^ "" pH Ncne c/; Taxic Flamrable corrosive explosive_ Bulk volune yX gal.;?gc>t>tons barrels^ other_

(42 gal) (specify) Ccntainers druns cartcns bags othjer /? *-'^K

(nunber) y (specify) Fnysicai Scaee: solid liquid sludge ^ ochjer '

(specify) SPECIAL HAJXLLiG DSTRUCTICNS (If any) " ' '

I certify that the above 'xaste is accurately descriced.

CFEST # imL .<U. \ JL . .kU. . .> . l . v.>..

-2 - Bureau of Sanicaticn 411 No. 24th Screec Fhoaiix Telephone Nunber 255-1160

ADHS APPROVAL DISPOSAL AI: (SiCe)

(Area of sice) /^

APPROVED BY

DATE:

Jrt4^A<-u/i^, jnc. '!Lt±

l]J0fn6t>. ^-J r ^A^s^ OF HEALTH SERVICES

kkkkkkkk

HAULER OF WASTE <^^^ be fn ied ouc by Hauler) ^ NAME Afi^/ z./)///^ P e . 7koA^ c/A^ C^o >7 T/ cu cA/o/?^ <> BUSINESS ADDRESS / ^ 6 ' /V- .5^7X /f//<g , PA<:)>e/i^X _ A J ^ • ^ r ^ ^ * / B

bkmber Screec

TELEPHONE m ^ C 7 - A o / '^^ PICK UP

tlcy"

THE am

Zip

tm JOB NO. NO. OF ICIADS/TRIPS (Daee) VEHICLE U C . :?

Flacbed Other (specify)

The described waste was h.auled by ce to the disposal facility named belcw and was accepted.

I CERTIIY THAT THE FOREGOING IS TRL'E AH) CORR

J Sij^cure of aucrjorized agene^cnd t i t l e

AAU^^^-^.

• X . i _ i . j , i , r L . t . i .

-V..;. HAZAPJQUS WASTE FACILITY (M^SC be fn ied in by Facnicy)

' , '\ SHE AXDRESS ^ y - l S 3 / ^ y 4 / J i / ^ y ^ /A- /

' ; ' (yiANTHY MEASLTRED AI SHE (If appUcable) ' AEKS PERMH NO. N/A

Ihe above-named hjauler delivered the described wasce Co this facn i ty and was acceoced chis dace. :- : ^^::--?;-•-

J l Signacure of authorized ageit and t i t l e

A^~:>^--77 Date

kir.

JDHIC'AL CCM-lE rrS: \

AlUZONA HAZARDCUS \HPSIE MANIFEST

Print or type a n informacion cn th i s form

MANIFEST - y y / < 2 7

I . PRODUCER OF WASTE (Mist be f n i e d out by Producer)

SA ^ / / a/c- CO. NAME

PICK UP ADDRESS / 0 7 . ( / - Xft / , :Al-C Nonber Street City

TELEPHONE NO. 2 2 A — M 1 ! ^DHS Facnicv ^ ^ 1 ^ (if applicable)

Zip

A SIC# TYPE QF PROCESS 5/o,<!,ff- WHICH PRCDUCED ViASIE 7"er

DESCRIPTICN CF -iASTE (masc be fined cue by Producer) Check type of waste:

1. acid soluCion

:^?//

y 2. 3. 4. 5. 6. 7.

Oth

8. 9.

10. 11. 12.

alkaline solucicn pesCicides painC sludge solveic . , te t rae thyl lead sludge 13. chemical t o n e t waste 14.

— 15. 2r (specify)

Cank boccan sedimeic o n 'v~^ '" . d r n i i n g mud concaminaced s o n 7 sand cannery wasCes lacex Xvasce mud and waCer brine

CONCENTIRATION

upper lower 7«

<5H

JL ) c • - —

z^-^-

ppn

CCMPCNETTS: (Ecanples: Hydrcchloric acid, lime, caust ic soda solvei ts (lists), metals ( l ists)) .

1. a y / l T C / 2. 3. 4. 5. 6. _ ~— — — m RAZAiUXUS PHGFERIIES CF WASIE: ,^^Ar~^^F~Z>^^/=, pH Ncne . Tcxic Flammable corrosive explosive Bulk' volune. jy^ gal.gOoC> tens barrels ^ other_^

(42 gal) (specify) Ccntainers druns cartcns bags_ oth.£r_ > i.V /v-

(nunber) Pitysical State: solid l iquid sludge t ^ cth^r

SPECLAL HAIXLE'G D';STRL'aiCNS (If any)

(specify)

(specify;

I certif/ chat the above waste is acc'..c:ately descriced,

a SIQ'ATL-RE ( X -A Cr-c/ r ''"- ''- / .

Tuiz AiP..r^a s:\ A'Af-8000128

IFEST •# b^iri -2 - Bureau of Sanitaticn 4 n No. 24th Street Fir)eii^-Telephone Nunber 255-U60

. ADHS APPROVAL

DISPOSAL AI: (Site)

(Acea of sice)

APPROVED BY:

DAIE: iriSiPi^'nA-.l^,

AAAAA' A <A <n»

H.AULER QF WASTE Oljse be f n i e d ouc by Hauler)

NAME A A A < ' I ^ 0 ^ ^ P&ykcA 'G 'c^ /^ Q y ^ A n ^ ^ c A ^ ^

BUSBESS ADDRESS /:>^5" A l / ' ^ ^ S T ^ Ahy^ . P/'iy^A^/K )A'y- S^S'd^-y^ 'Numer ' ^ Streee '' ' Cicy H ^

TFTFPHONE NO. ^ ( p ^ - 6/OC PICKUP TIME am cm .(Date) JOB NO. NO. OF ICAXS/TRIPS'

VEHICLE: Vacuun Tnxk vnncLE: uc . :>:?.sT6//

Flatbed Other (speciiy)

The described waste was h.auled by me to th.e disposal facility named belcw and was accepced.

I CERHFiT IHAT IHE FOREGOING IS IHJE AUD C0R5

Signature of authorized ageftc-and title

-"^s. ' - ' i.-V ' '. ' '

V. HAZARJOUS WASTE FACILITY O l ^ t be f n i e d in by Facn i ty )

ADHS PERMH NO. N/A ::;;.; SHE ADDRESS y^-r'.'sSX^Ay^y^t y ^ ^ ^ ^ ' ^

i A ' QUANTirY MEASURED AT S H E (If applicable) --

:;• Ihe above-named hauler delivered the described wasce to this facnity and vns ';•;•"• accepced chis dace.

>igpacure of authorized agent and title ^ ^ -^ P ?

Dace •rX- ; -

r . 4 . . 1 . . ^ . - . t . . \ ^ \

JDHICNAL CCM^enS:

ARIZOIA HAZARDCUS VIASTE M.ANIFEST MANIFEST {i (y ^f.A-)

Princ or cype a H informacion on t h i s form

• ^ A - '

I . PRODUCER OF WASTE (Misc be f n i ^ ouc by Producer) ^ ;

NAME -^/i e I f Of c : c : o . PICK UP ADDRESS 10? A/. "i Q? AC^^ AAoC r r C H j

. Nonber Streec Cicy Zip

TELEPHO E NO. 2 1 - 2 - ' ^ ^ y ADHS FacniCv #___N/A ( i f ^qjplicable)

TYPE OF PROCESS STO'M fc-r TA/AF: S>Los>(r^ WHICH PRCDUCED ViASTE T ^ T A SIC # ^ ? / /

DESCRIPTICN CF -iASTE (nnsC be f i n e d cue by Producer) Check Cype of \'SsCe:

. 1. acid solueicn ^ 8 . Cank boctcm^,sedimeic 2. a lkal ine solution : . :9. o n 3 . pest ic ides , 10. d r n i i n g mud 4. painc sludge . 11 . ccncaninaced s o n 7 sand 5. solveic • 12. cannery wasces 6. Cecraechyl lead sludge 13. laCex wasCe 7. chanical t o n e t ^caste 14. mud and water

Othjer (specify) 15. brine

.>

CCMPCNn^: CCNCENIRATICN (Exanples: Hydrcchlcric acid, lime, caustic scda solvei ts upper lo^cer X ppn (lists), metals (l ists)).

1. LUAreA ' S 's^ 2. 3. Avi-'-C?" y 4. 5. 6. HA.ZA.S1XUS PROPERTIES OF WA.STE: /'^TrTh^^-'TTrA^ pH NcnC' / Tcxic Flamrable corrosive explosive ft.ilk volune u ^ ga l . ^o^ tons barrels^ other

. — (42 gal) (specify) Ccntainers druns cartcns bags othier '^'•'^ ! ^

(ni.7nber) (specify) • p t _ . _ 4 — 1 C l — - _ , — I J J i - ' _ , - ' j - i . . j _ _ , y . . . . . . u — . 1 iijr a x ^ . o I. i j u c u c cv.ij.jjJ. .^j.^i.i I l.t oxv. . i . ' r ,c j y y^\,.J!Zi.

^A f ^ i ) f - f .

^ / ' ^ -c?-C- .

(speciry) SPECIAL HAIXLDC LSTRUCHCMS (If any)

I cer t i fy that the above waste i s acc j ra te ly descriced,

^ - / - ^ ' - ' J ' ^ f SICVuVRE A - ^ (S .U-^ ' JA ' 8000129 ' ;T I I r r . I ' y . , ,r > ^ < / 7 ' - ,

.., 1 i v.. ' cu^ ' . \ III ' . i j i i . i \ .Vi.L.i;o

tiiijLxi-ji ir (-y i . / .y -2- Bureau of Sanitation . . . . . . , 4 n Fo. 24 th Street Phoeriix

Telephone >UEber 255-n60

n , ADHS APPROVAL DISPOSAL AT: (SiCe) ^jAid/)/^AAlnx f/}\ •

: A ( - / J > ' (Area of sice)

APPROVED BY: xA'jAK 4 r . ( ^ A ? l d -,. -^ ' """"*" j m ^ l £ ^ OF HEALW SERVICES DA3Z: / 9 hJl^Pnh- '^y?

A A A A A A A A

d . HAULER OF WASTE C^C be fn ied cue by Hauler) NAME Ahty^^o^//^ . P-eJ oA-e y ,- C^ichd^cJd/tC, BUSINESS ADDRESS / c P ^ /^ - ,5"$>7^ . P/^O/^yV/x / ^ ^ ^ ^ ( ^ ^ 3

,t«mber Streec . / Cicy Zip^ TELEPHONE ND.P'^ ? ~ AP/0 (QYLCZ, UP - TIME am pn

JOB NO. ND. OF liOAXS/TRIPS^^^^^ VEHICLE UC. =}££AAi[L VEHICLE: Vacuun Truck > y Flacbed Other

(specify)"' Ihe described waste w as hauled by ce to the disposal facil i ty named belcw and was accepted.

I CERTIFY IHAT TKE FOREGOING IS TRUE AND

iture of authcrired agenbvaid t i t l e

^ HAZAPJQUS WASTE FACILITY (^iist be fnied in by Facnity) •TTT: 7 = ^ - y

,•;;/:;; SHE ADDRESS ,<^,5".5^/f/^^/^/7 /ypyu/0^///_ / ADHS PEFMH NO. N/A ;;,,. MlcyiANTHY >n:ASURED AT SHE (If applicable) '" : <?: ;; -;>'; The above-named hauler delivered the; described vJaste to this facn i ty and was

B;sij(^accepted this dace. ,.. .,

• ^'AAiJu^^^ • . : ^ / i ( , ^ 7 f ' • '• • - • - -^' '" • ••- • •- x ; ? - v ^ - 7 / :-:.. /Tu'i Signat; a or authonrea agenc and c ic le ' Dace '-A\AAAAi! & : i- . . . . . . . - . H : . •'•;••-''"•••''••'•''•

r n C N A L C C M - E N T S :

AIOZONA HAZARDCUS ViASTE MANIFEST MANIrEST # A ^ . T - I

Princ or type a n informacion on th i s form

I . ' PRODUCER QF WASTE Oiisc be fnied^ouC by Producer)

RAME ^ ' l ^ ^ / f C^fl^ C^O ' PICK UP ADDRESS / O ? A/ S ^ . ^ / Ai-'^ . A^lj-oC .fSlDCJ

Nonber Screec CiCy * Zip

TELEPHONE VCt . Z J J A I J I ^ J I . ^DHS FacniCv r ^^^ ( i f applicable)

TYPE QF PROCESS•^^^"^"'^^'^ ^ ' ' '^ '^ ' 5 4.L'^'>5-^-vHICH PRIXUCED ViASTE T e - T A SIC ^ o^^A/

DESCRIPTICN OF -i STE (musC be f i n e d cur by Producer) Check cype of leasee:

. 1. acid soluCion J ^ 8. Cank boccan-sedimeic 2. a lkal ine solucicn 9, o n 3 . pesCicides _ _ I 0 ' d r n i i n g mud 4. painc sludge ( 11 . concaninaced s o n 7 sand 5. solveic 12. cannery x-ssces 6. Cecraechyl lead sludge 13. laCex wasce 7. chtemical ConeC waste 14. mud and water

Othjer (specify) 15. brine

CCMPCNETTS: CO^K^^TrRATION (Exatples: Hydrcchloric acid, lime, caust ic scda solvei ts upper loxver 7o ppn ( l i s t s ) , metals ( l i s t s ) ) .

1. UAA T < V ___ ^ r ± 2 . .S'/ i -V"^

r

:'£:^IZS CF WASTE: f^T~^J^c-~7^f^^ pH Naie^-^Tcncic : Flamrable ccrrosive explosive Bulk volune i ^ galy^o&P tons barrels^^ other__^

(42 gal) (specify) Ccntainers • druns careens bags ochjer /^^^'{-J^

(m.inber) (specify) Fnysicai State: solid l i qu id sludge v,.^'^tr.£r

(speciry) SPECIAL HA^XUir; DSTRUCIICNS (If any) " ' '

I ce r t i fy that the above waste i s accurately descriced.

DATE l i l ' ' ^ ' ' ^ ' ' i ( SIQ'ATL'RE l \ - ^ • W<^^r, ' -V.J

-^(^ - r - A.\ l ' - l 8000130

A/i'^/y> EEPARIMGTT QF HEALIH SERVICES .lEESr T? ( A ' ^ l - 2 - ' Bureau of Sani ta t icn

4 n Vo. 24th St ree t Pbo-aiix Telephcne Mrober 255-1160

:. ADHS APPROVAL

DISPOSAL AT: (Si te) Jxt'i4-^wAl--yrJ^^ (Area of sice) // JjA- I ( I

~ ^ y

DAIE: /Q/k0cryiAc2, A'/

KsmmD BY: f >AVAfAa.iCr=~/nOAly^^ "^ DEP RIMENT OF HEALTH "sERVldllS

ki '^ 'kkkkk

I . HAULER OF WASTE (M^st be f n i e d out by Hauler) NAME / A e / 7^0/Vf1 P^/ef^A.^u /^ & / 1 ^ - ^ ^ ^ r v / e J j ^ C BUSDIESS ADDRESS / ^ S " y /^ - j 5 ^ r 7 t . PAfo-eyj/X, /A^^ ^ S ' ^ ' A S '.

Nunber Streec City Zip

am nn TEEZPHCNE NoP^7-<^/^<^ PICK UP _____^__ T H E

JOB NO. NO. OF LOADS/TRIPS^^^^^ VEHICLE UC. ->rJ?^:i--6l/ VEHICLE; Vacuun Truck -^ Flacbed Cth.2r "

(specify) The described wasCe was hauled by ce Co Chja disposal facility namjed belcw and was accepted.

I CERTIFY IHAT THE FOREGOING IS TRUE ^ m

•thorized a rsie ard title

. • , • ' - . - • • ' • ' ' " " ^

tv . HAZAPJQUS WASTE FACILITY C ^ t be f n i e d in by F a c n i t y )

i;,: :,SHE ADDRESS//^5^/»?v^/'//^ A ^ I / ^ O F / / J . 7 AEHS PERMH NO. N/A ; i ' • :(yiANrnY MEASURED AT SHE (If applicable)

7 .The above-named hauler delivered the described wasce to th i s f a c n i t y and vss • ; : : : accepced chis dace.

' Signacur^'^ or auehorizec agenc and e i e l e Date \

ADDmC IAL CO- E^TTS: