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IN �rpa¢tQT (4rraodi Du�91 r �1�M0}'4}�l i" b'Udut(e•., <br /> I' T. mist pal'ar dream rllN•Il pphcNl yPmwnNr '1 Dopaenkhld Twlc Subrkemrp, .. <br /> amenro Cakfdtnlb <br /> i N tM HAZARDOUS I. Gmwalor'r US EPA IDNp,, , MaAlhrtDpomml:Nh. 2 Popel InfWmgflob to rhe an6r <br /> �'� "W TE MANIFEST 001011 U 3 6e�hlevva�4GPd <br /> 0 eI -�i ICE CF <br /> 3. OrneratW1 Name and MaiBng ." - <br /> 70 s "PI 0'r r,�, i Co � . . ks.,dr 1 <br /> ' Z 000 ctin $n P Gclop <br /> o.�m n, C A p / <br /> A. Genwaror'rPho <br /> . ne( I7. <br /> R' n` S - _ D'Jr <br /> 5 TranrponW F Com//pppany Name 6. US EPA ID Numbr { �4e I(: " <br /> �: l�- . � � IS,res C 24 � ,^� .�1 � �` y4t•" (y <br /> , <br /> 7. irampwtpr 2Eompany Nam B. OR ID Nu�r4 mbw + <br /> w <br /> Ll9 <br /> 9. Deripnabd fadliry <br /> in and SMLOerr 10. UB EPA ID Nemher 91aIr1 0 r< �r�.rosb -F oQ16 <br /> St <br /> N=Q ac, q0<6 1 J CIAI DID1 <br /> ND I I. US DOT Dekcriplion(including Proper Shipping Nome,H.Id Clair,and ID Numbed 12. Can men 13. Tmal l e Ua t <br /> No. <br /> Z o 7 OuanH WUVd .J Warty Nvrd». <br /> r t- rf ol K G H N7_a dlo k s cc s ebb <br /> N <br /> E L i LA. 1 O / D A/CNhw <br /> I'+� v A DISK7tAt.. wArE WAS <br /> w 0 t 71f8 R11t0U11R5TtPhVYipRYDFPARTME,VYTM. NC FOR BSgOII@? 9AaN `�� <br /> f R cku AND STAKE AiIOND�pI Ara �XICSD STA� p 1pAJo�hw �: <br /> •.. RDWGLY W RBLTG$tKID WA$M 'ATON TtA W1Dl vImNS OP <br /> Vr" V AN ALL ne AJ ORR, ICA]( <br /> I � r <br /> � S�y 5 P1{I I l ^�eF ✓� � f'� m1 i ` 1 lr`b'^%W. <br /> I , t rCai+i r" � ��/ ;v"^1N+FYY+LNytalt r 5' + N+n '.aP •Fn�„� 'r a :; 511 .RFvnvdi'} `}. «.i+ <br /> .Y .s,.lnrL,bM=x1 U.J re r. ,c. , <br /> IS. Spic al Handling Inrb«eonr and Addit onal In(ormeeom 1 <br /> 1/k�Ar Q•niorp�fr f7rN <br /> Z4 C e. nLs p 0AK a <br /> yf o <br /> _ <br /> 16L GENERATOR'S CERTIFICATION:.I Mnhyddgn lNlf{vhe pnpmr of Mir anrianmenterefully andaceu ahly dearib�lobowh re rdippin mme and do clowified, ked, <br /> V marked,and lobe ed,and oro jn all M".m propw condition hr kdnrpotl by highway accerding b applicable mMrwtlono and ncfiorwl pwam,Mnl rpulofionr. e <br /> If I nm a terga quanliq genonror,I aarNhj HtM l haw a pr�ram in plop to rodu 16 velums and bxicity al wow gopr.l d ea the d.pno I harm dekrmined w M-onomkally <br /> .F y pracdcabN oad that I Mee whcW IM ppracticable method of menLnmr,rlarapo or dlipmal cumendy arolhbh Na m.whkh minlmireo 1M pnwnl and Unum lbred m human h :11 X <br /> and Iho enmenmmt;OR,If I am a rmall quantity generator,I have made a Road fallh Ofad d minlMhe my naw gmerdtion and Taloa the bnt wwh marmpemw,l..,had that is <br /> moilabl.roma and that I'can afford. <br /> Prim /Typed Namer- 1 5 O Signaturo Month Year <br /> W r/ a ! I ?jItl 03 <br /> 117.'Tram ver T Acknowl emml aF R.1p,d MoN W. <br /> $W$ N, Fin /Typw�,d Na�r9Ee 1 Signalu Manlh Day Ywr <br /> W F fplLA CA/ I Z O <br /> 13 <br /> Y! a 18. Trois a r6r 2 Acknowlad omenr OF Ro i t d Mot I, <br /> QV I Fi /T ed Name 31gnaN Manlh Day Vwr <br /> lJ R 19 Dhponry Ind,(calion$Pop <br /> C <br /> 'l " <br /> 1 20. «III Qwh r of O br orti c lien rete t of Mwrdom mowriob cb «. Ihir mani(oit ext ae noted In Ihm 19. <br /> 4 DO NOT WRITE BELOW THIS LINE. �/ <br /> yellow: I 5 SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> a-"nr"or"•'^'^"„ �. ,^fin wev,a.•+:.f vnC .. .wade h iC:F,.�,r:ir in . <br /> .r. LAI i': <br />