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p. 2 <br /> Oct 29 04 10: 15a - <br /> L <br /> n;c-?f7jC-4D39{Expires 9-30-91)Protection Agancy 9-30-99) 'Srv'B I7Sy7flIC:Tl Oi75 OL: pQ�°L = .. �npert�-,��..o - <br /> f,caic Substcnces Cnn:�r <br /> rte. `arm designed for use an etre f i2-Pi. �pewrrter. Sc r'c.renta.=aiisorn is <br /> 1, Generator's US EPA ID No. Manifest'vecumanr ,,he h_ao areas <br /> -3. ;A1MRiVt HAZARDOUS I i..art -ed Fecera9 in, <br /> WASTE MANIFEST 1571, 3 <br /> C I i1±1 101!21 IcJ <br /> A. Stara Murtiirm Dc-,men,Number <br /> ? Genera!ar's Nome and Mailing Address <br /> a S'i + 4L <br /> ��'^^7 •� B. Stale Gcnere!or's M <br /> ua'ar':ehene I G C <br /> 5. -ransoorter i Gampaay Name <br /> E. US EPA ID Numb-• C. Sscle Trunsparser's'.G ?otervec,l <br /> r �s <br /> Franspo <br /> - B. US EPA ID Number I E. Sidle Tran porter':iD(?rsar•.ed] <br /> 7. Tronsparrsr 2 Cem Y Nam <br /> ` € Lransponr',Pkcrc <br /> State Facik',;ID <br /> Designateccili ty Nam6 and Sile Ado'ress 10. US EPA ID Number <br /> Z, C ifl C <br /> Coma;nec '.3 Tcta 14. Ung• <br /> d <br /> 1 1. US DQ7 Description lineluding Proper Shipping Nome.Hazard Class,and ID Numbed No IYf-e 'Va,ttlV W:"/ol Wase Number <br /> 5ta.�• <br /> E <br /> N <br /> ZE :€A/Other <br /> �Slate <br /> A C. <br /> T <br /> 0 E'A/Gther <br /> R s.Dle <br /> i <br /> I 'cy d I <br /> ' EPA:31her <br /> ,� ��� .iC. F,ondlirq Odes rar Wcs•er I,led An., <br /> z '. Additional Desc• t` as for Motena is ACo t� <br /> etc <br /> 1_ <br /> t a. Special Handling Instructions and Additional Informotion10 <br /> 16. GENERATOW5 CERTIFICATION: I hereby declare that the conrenrs o t is camionment are fully and occvrately deo-cn bed rbcve n p•caer$h;paame and nr c .ke rocked <br /> < marked,and labeled,❑nd are in all respects in Preper condition for Iransporl by highway according to opciicable:nternoda of ,r.n.!iora a..v-n ne I rrn.mr.ns <br /> II tl am a'ivrge quanhry generator,I certify that I have a program it place to reduce&.volume and Iox,city of wcs'e ge�erarsad to IgE degree 14'a aele n r.d In be e[DnoT�tolly <br /> UL 11;amahie ord that t have selectee the raoicab'te method o. art inenr,storage,or disposal<urcently ova:iabtle to me whic*.m r nius he preser•s and tutu threat to numon ncalt� <br /> p <br /> ono fhe envrranmenl',4R,if i am a small quantity generator,I have made a good foith effort to minimize my waste gencraf'cn arc:elect the ac=1 wa.ro msnagemenl cneho - <br /> ovoiloble to me and that f can afford, <br /> C Signor f � r.lnrth D^: Year <br /> r Printed/Typed Nome r G tf 0 <br /> 1i 1 17 Trarsvvtse•1 Ackrvwlea emenl of Receipt of Materka is <br /> rno•ah Fav Year <br /> w p Pr'nted/Typed Neme 5ignol <br /> �. <br /> P '8 Trcnsoorler 2 Ackna•.vled.amenl of Recei t of renals rq_,t,, Day Yeaf� <br /> O R 5: n <br /> T' Prinledi�-v�rl Norm. _ Se `r <br /> 19. Dlacrepan indication Space <br /> _ F <br /> A <br /> 4 <br /> 20. Foci htr Cwner or Oasratcr Cerllficelion of receiat of kezardoos m,n'-ries revered 5 )his mar':est n:ec:oc toted in.Item I= Ga.yen- <br /> 7 P•intee lT+ced Name g <br /> le <br /> DO NOT 'INMTE BELOW THIS L;;,,:E. <br />