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y�=..:' ear.. L' � a-�- � • <br />9i smATdmmiihsiANA tl € <br />DEPARTMENT OF ENVIRON,MENT�lIQUAC <br />l- HAZXRDOUS WASTE DIVIWION <br />P BO`{ 82178 <br />`BATON ROU , LOUISIANA 7QS84-2A78 . <br />a <br />PLEASE PAINT OA €Fnrmitnsinned for i6e on elite i12-oitchl tvnewriter.l %OLf Form Aonroved- OMS No. 2050-0039. Exoires 9.30-96 <br />EPA Form 8700-22k(Tev. 9188) Previous edition isrpbsolete. <br />COPY 2: FACIL'TY TA GENERATOR <br />DEC) FORM HW -3 (A 9194) <br />UNIFO HAZARDOUSGenOratol's <br />U5 EPA ID No. � a an I est <br />1. m 1 <br />` "t- <br />ADI 0l 01 9 11 8 91 1I <br />2. Page 1 <br />1 <br />Information in flue shaded areas <br />by Federal law. - <br />WQ MQNiFESi' <br />yl 6I 1 S I <br />I <br />of <br />is not required <br />3. Generator's ce rUctureS Corporation <br />- 3'u <br />A State Manif °°� u e N m r <br />A1,7 <br />Ai'rnort oda�+ <br />4 <br />s. erg <br />r�_ <br />Stocitton, CA 206 Atte: Lon Kitagawa <br />20 <br />_, 983-3339 <br />,1 � • X E M -'P T <br />4. Generators Phone <br />` <br />5. Transporter 1 Company N 6. US EPA ID Number <br />.Stele o—w-f ID A-019 1A <br />Nort11 S e E viroT[IiLrltaA D 9 <br />D. Transporter'*ftne <br />10 11 113 16 13 17 13 93 <br />7. Transporter 2 Company N US EPA, ID Number <br />E. testa 4arlspa 4 � <br />Hunvxidl <br />J B Commodities :A !R 1 9 i a I i � 910 I8 1515 13. <br />F. Titansportar"sPhone 'tt-000),368-8539 <br />9. Designated FacilityNama erid a Address ' . 10• U EAI Number <br />`4- State Fracllky's f� <br />MA W& SHALE Pte,, SIC. . <br />€ j . <br />968 kII�NWAY 90 EASE _ L A O !i i 0 7 T <br />K Farilltys Phorle <br />MORGAN CrrY. LOMMM 1 1 1 I I I 1 t i F 1 I <br />9121"aM: f <br />11, US, DOT Dewipdon (4rrcluding Proper Shipping Name, Hazard Clem and iD Number) ._. -- <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />;it.rWaste No. <br />No. I Type <br />Quantity <br />WI/Vo <br />a <br />Waage Flanmble tiquid5, BIOS, 3, fY41993, PGII <br />0 0 1 <br />n <br />P <br />o - <br />(latex,itr ic_nloroethane) <br />R <br />b. dazardo �Tas' Soli.' -4, NOS, 9, NA307/, PG111 <br />w 1 I <br />r <br />p <br />R <br />E <br />(chromfia RQ-1� <br />O L O <br />R <br />A <br />c. <br />T <br />R <br />R <br />d. <br />R <br />J. Additional Descriptions for Materials Listed Above MCI= humK. <br />Handling Codes for Wastes Listed Above <br />TSTF.�rT!ilP 4 �s ?/ 1JR, Lab -packs.-,- .- .sem attached lists <br />�ur l <br />M032 <br />or contf3n s: A: 1, i5gal fiber drLn. <br />proc <br />1i5 S " redaen fuel fn greg r C+antxfac ur ing . <br />ss. <br />15. Special Handling Instructions and Additional Information <br />4 <br />Emergency Contact: Lon Kitagawa (209) 983-3339 or (209) 982-91G0. <br />Use appropriateotective clothi and respirator if drums are opened. <br />DRIVER CARRIES ff4ERGENCY RESPONSE, WIDE.: <br />ri <br />ENERATOR'$ EFM ATTON: I.ha/eoy declare tim ms corri nts or this consignment an tufty and accurately described above* by proper shipping name art ire classified.. packed. marked. <br />#rd labeled and are Inaft respects In proper condition for transport by -highway according to applicable international and national ggvertsmertf reputations- <br />Ir 1 am a large quanuty generator, I certify trial I have a program in place to reduca the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have <br />selected the practicable method of ireelmem. storage. or disposal curiantly available to me which minim" the present and future threat to human health and the environment- OR, If I am a small quantity <br />generator. 1 have made a good laith Orion to, minimize my waste generation and select the beat waste management Alathod that Is avallati4a to me and that I Can afford. <br />nntedlTyped Name <br />S' r Month Day Year <br />U%A kit r W <br />DY 5'9 <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed Arne <br />Sign urs Month Day Year <br />s <br />s <br />P <br />a <br />� 18. Transporter 2 Acknowledgement of Receipt of Materials <br />r <br />Pri d/Typed Nap <br />Sig tore ' Month Day Year <br />19, Discrepancy Indication Space f <br />F <br />_ <br />A <br />C <br />I <br />1 <br />L <br />I <br />T <br />20. ility Owner or operator: Certification of receipt of hazardous :materials covered rn <br />is anif t except as noted in Item 19. <br />Y <br />I tediT ped Na <br />y <br />Si natu Month Da Ye <br />9 C Year <br />a� <br />EPA Form 8700-22k(Tev. 9188) Previous edition isrpbsolete. <br />COPY 2: FACIL'TY TA GENERATOR <br />DEC) FORM HW -3 (A 9194) <br />