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SRGENCY CONTACT TELEPHONE NUMB <br />r777777777" <br />I <br />UNIFORM HAZARDO US 21, Generator's US EPA ID No. Manifest <br />22. Page lnformatbr) in the shaded areas is not <br />Document No. <br />WASTE MANIFEST <br />required by Federai law. <br />(Continuation Sheet); X1 A) -D .8 .9 <br />23. Generator's Name <br />L. State Manifest Document Number <br />Appla,ed A,eL-ossp2am 3trtzcturmw Corp. <br />24-27 3outh Aicip,--it rt FiAy; R .0 - <br />i� <br />K State Generator's 10 <br />2 ORT;4 9 RT3"-'13 <br />9 <br />24. Transporter 2 Company Name 25. US EPA ID Number <br />N. State Transporters ID <br />O. Transporter's Phone <br />. . . . . . . . . <br />26, Transporter Company Name 27. US EPA ID Number <br />P, State Transporter's ID <br />Q. Transporter's Phone <br />. . . . . . . . . . . <br />28. Us <br />DOT Description (Induaing Proper Shipping Name. Hazard Class, and IDNumber) <br />29. Containers <br />30. <br />Total <br />31 <br />ti 11 <br />R <br />HM <br />No Type <br />Quantity <br />wtivol <br />Waste No. <br />a. <br />Faar h4 V;,A z dot�-w vw-- ta ol. -.td, n 0.!s i-oTaj,�iiz) r 4RA <br />C& <br />b. <br />Namardoll's T4;z 5 t v <br />X <br />0.1 -T-d e fl - --'�t-- t t2 C, is e - t - h 1? 1 9t. rm91 0 "7".7 P G1 11 <br />C. <br />L4 <br />Utd f.T1 .41 r, PC r L- I I I -D r C. e t -h -311 e n. e or <br />G <br />d. <br />ha 0 a r dra U-07 was'ta <br />E <br />N <br />i?eq 11 in . C j Dorc).m.Mj-.h2 Ile r j. <br />E <br />�)O <br />J.."M <br />po i <br />ZT011, <br />R <br />A <br />T <br />e. <br />RQ, wazt:,e proll <br />0 <br />K <br />R <br />DO 0 L <br />4 <br />T V a M1*12 64, pGi"r (Vt D 0 0 2:1' <br />llqiiiai� Jjydrr-41uc-,ri,2 <br />cj a <br />PG-11 <br />D 0 <br />;.4 {.F a.iFr PGII <br />S, Additional Descriptions for tvlate—da-ls Listed Above T. Handling Codes for Wastes Lis-,ed Aboxx <br />yy <br />4, -6a is <br />92, Special Handling *structions and Addl0briall Informatloff ti <br />'A <br />a) ERG-# 17-1 b) ERG# 171 171 5; ERG# '12-4 f) ERG# 154 g) 15'0. h) <br />17 1, d) ERO L <br />ERGP# J-5 <br />ill. <br />2-3 Ni7;UR <br />3-+ <br />T 33. Transporter -'d Acknowledgement of Receipt of Materials <br />R <br />Date <br />A PrintediTyped Name <br />Signature <br />Month Date Year <br />IN <br />S <br />P <br />0 34. Transporter 4 Acknowledgement of Receipt of Materials <br />A — <br />Date <br />T Printed/Typed Name <br />Signature <br />Month Date Year <br />E <br />R <br />