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-fAN 15 '817 05;52 P.212 <br />frMt or type; use on CA&q-pltch) typewriter.) F0,M APProveO, VW) M. 200.OWM E -n;" -s 0 <br />U 21 <br />AF,0RM.KAZMD0 I$ GM!Uor-s 0f rpA io No. Mwiiost Document M4, <br />-2. page -information in the shaded <br />';�;-%WASTZMANIFEST• <br />1. . .. I <br />i I in 1.1 <br />vT q4-4- 11, . <br />.r (COhtintii#6 I 4-6A <br />areas Is not required by Fiaeraiv <br />, - - - ; r .; . 1 <br />I ... i , :& <br />I iaw.,!:j! i,- .1,:• <br />ran toeese Na 0 <br />pan/ <br />A <br />24, Transporter �i25. US EPA ID Number <br />q?mpany Name <br />-.St <br />- 71 <br />q bp <br />26,- Transporter' ,,, Company Name 27. US EPA ID Number <br />P; st <br />r 8 <br />.0-1......'... <br />28. USDOT Des&lption (IncWing ProW Shipping Name, Hazard Class, and ID Number) <br />29. Containers <br />30. <br />Total <br />Unit' <br />No. Type <br />Quantity <br />wt/vol <br />a. <br />rON <br />RCRA ffAZAR=-S <br />(CrVsw <br />D/M <br />2-7- S® <br />b. <br />MON <br />bas'. ease coo-tvAlfAaf-ei ara;i) <br />qr <br />C. <br />................ <br />Wdsfe- Rxivi+ klaWhm je r jCA I, 117vicl,A- <br />ON 12&3 Ra (Dco)) rx-t* <br />Z <br />A <br />. <br />0- <br />— <br />901V RCIZ A 1+42A wdsfe� I-IjvkA <br />T <br />0 <br />(I.J-CX VJ,24e( 6a:5ed ?qjr1+5) <br />7 <br />VVO M V V A- R47 R VWS IV Kr�-' 5 0 LT: 0 <br />;X4 <br />9- <br />"Sfe Pa"At, F14r4A1aLde_ L il"fel, GN 1263.;, <br />T'4 -'t 111-M, <br />No'ki-cavue. vvic+o �;Olfots) <br />?w <br />I <br />n. <br />Fiat •.:...j 11•, �Iptlohj falf An'lVate,641s: Listed Abb*, <br />"A 2 <br />4f;)�..7. 15 <br />W9,4EI, <br />K%j 20 <br />ilk, <br />4t• U2. <br />-e <br />4 Y:, <br />32. Special Handling Instructions and Additional Information <br />r <br />33. Transporter _ Acknowledgoment of Aeceipt of Materials Date <br />APrintedlTypod <br />N <br />Name <br />Signature onth Day Year <br />a <br />P <br />a <br />34. Ttansparter.,.—�- Acknowledgement of Receipt of Materials Date <br />A <br />r <br />Printed/Typed Name <br />Signature onth Day Year <br />A <br />35, Discrepancy Indication Space <br />pa <br />L <br />I <br />T <br />SyclFIGARV-6 LARELMA6TgR,blv.*IAMERCANLABEI.MARKCO..CF41CAGO.ILOOW BWQI$O <br />JUL 14 '93 08:09 <br />EPA F01M AYOO,22 A (ftwt $-#a) ftowiW& G&KNU are abadvie <br />.1 .. . <br />