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LA <br />w merilpl PratecMo Agency <br />OMB Na Z050:M39 <br />Expires 9,3094) <br />or type Fgrm (Iw'pned,�ar use on oghtfr2y pewnrer. <br />v 'egs <br />I Toxic $ubaomes Con. <br />Is <br />�.mw.,., n,N -1; Oirrralart/-.US EP/l•IQ No. '.. _ at r in thl.�IWd[d arwt <br />UNIFORM' HATARDOUS <br />?},N mQpreq by, � rellaw. <br />WASTE tAANIFEST. <br />3. rator s N Haling Add r s"a <br />. acr `';:arf1 n j' ThrS3�b , ,vv <br />5 Transporter 1 Cam Name 6. 11S EPA 1D ➢timber <br />AL D P UM'--:- - CI'Al Ll OfLO1 0.1, 1 <br />c <br />7. Tian rter2. Name E. US EPA ID Nam <br />'p° ri , <br />cENV;ROPUA <br />9 Designated Facility Wow and Sal. Addrew ID..US EPA ID Nun+bar <br />JRWST v <br />i <br />13331_ N - W, W , = <br />c <br />PATTERSON 'to 95363 C AlOI 0 �8I 3,1 4, z 2 <br />/ <br />- <br />-.. _ <br />2' <br />11. SUS DOTDescription fhsdud ng Proper $lopping Name, Hazard Class, and ID Nsurbrf e1CO~dXfew a <br />2ilU:. ;'..7 •`='flue <br />> No. ,.n /Yo1. <br />/ <br />4 24'<zAiS G✓!r5-�' LI/G✓rU •k'r ,ithl ,"} <br />E <br />i N <br />Is. <br />! v +sr <br />i REPA�/OMmi <br />" .. <br />A <br />T <br />O. <br />a. <br />State <br />d �All <br />.. <br />t <br />y --, rS, � <br />•.. fr"3 }'!.._`. i t .l, <br />.I.. ��..s r.k ,.z: E aw <br />1S. Special Handling loorucnans and Additional W.n adm- <�_• <br />USE APPROP}IATE PROTECTIVE GEAR <br />p u' S•.Sau Gl< <br />DESIGNATEDFACILITY EMERGENCY CONTACT # (800) $7"444ij <br />GENERATOR EMERGENCY CONTACT AV' �/ Sc/t(- t/ 67 <br />16. GENERATOR'S CERTIFICATION: I hereby declam that the contents of the consignment on fully and accurately described obaw by proper skipping name and are classified, <br />packed, marked, and labeled, and are in all nep rch In proper condition far transport by highway according to applicable federal, state and imarnaticnal laws. <br />If I am a large quantity generator, I certify that I haw a program in place to reduce the wlume and toxicity of waste generated to the degme I have determined to be <br />economically practicable and that I haw wlacted the practicabla'Tnethod of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human heolth and the am4nwmmt, OR, if I am a small quantity gemrabr, I haw made a good faith effort to minimize my waste generation and select the best <br />waste management method that is awilable to me and that I can afford.' <br />Printed/Typed Name 'l <br />Sigmmra �r Hyl. <br />Monthh Day Yec <br />r <br />17. Transporter 1 Acknowled erne! t of R ei t of Material <br />' A <br />Palmed/TYPed <br />9gmnsn - <br />Month Day .Y. a <br />0 <br />18. Transporter 2 Acknowled emenl of R 6i'l of MaterialsRPrinted/Typed <br />Name <br />gra <br />S ature <br />Month Day Yew <br />e <br />19. Discrepancy Indication Space <br />F" <br />A <br />C <br />I <br />L <br />1-- <br />20. Facilit, Owner or Operate, Certification of ..it of hazardous materials cawred by this manifest arca t as rated in Item 19. <br />T <br />Printed/Typed Name <br />SigmNm ( <br />Month Day Ye. <br />1r' l I r <br />r�' <br />I A.�L. s -L.,. <br />DO NOT WHITE BELOW THIS LINE. <br />DT5C 8022A (7/92) <br />EPA 8700-22 <br />Green: HAULER RETAIN'. <br />