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Oct 29 04 10 15a : . <br /> . . yrly rCIStpUCf1Qr45 On bock ge 6. Deparerenla Toz' 5.sbslances Com.. <br /> s _.- oc roman a Cm.'rarnio <br /> •'1.� r'� ,g!s' 1. <br /> Generator's U5 EPA ID No. Manifest�fiacumarf Na. I 2. °ane } .aro nr7, n n r•+_.Faded crass <br /> r v' a�?A US 7,*1 0� a net r-rfeiree 6r Federal low. <br /> TJIANFFEST 11 �i tom' cc <br /> A. Slate+munTlest Doeumont Number �. +•t F ^ <br /> 3 Grneratar's Nomeand Mailing Address <br /> _ �� +•• j• '1 /fes' <br /> B. Slate:eneraro(!IC <br /> .� I , <br /> �. 5eneralor's phone; 1�4i' } t y��%+ R <br /> F Stcte Trans orw%ID;Reserved] <br /> 5. Tran po te-1,Company Name 6. US EPA ID Number P <br /> -- ++yy _ ��,�T •r+.rvtvre_r,r I D. Trcnsporrer's Ph—t <br /> -- PHTLi tL'rf? ..93"s t.Y"+'h_ i» .�3'. �I ! 3 P• rf1 `s31 l�,I <br /> T?Tfv-V' T AmT T �•!•Tf'r f' I - _ <br /> ` '� 7. lrarsparter 2 Camadny Name 6. US EPA ID Num6er i E. SEcte Transporter' IC(P.eservedT� <br /> F.Transporter':Phone <br /> C G. State Focii!N's iC <br /> �-' 9. Desigrto•ec Facility Nom®and Site Address 10 US EPA ID Number- <br /> t <br /> �' `-%j 'l,CEy -LYC H. Facility'.Phone <br /> Cr.� }rx, .n S y'. <br /> DRIVE <br /> 12. Cort— TCio+ 1 A. Llrn+ <br /> US DOT Description(including Proper Shipping Name,Hazard Class,and ID Num6er) No Type Quantiy WI/Val I. Waste Num6er <br /> �' R State <br /> a. <br /> LS FSA '- S01JD <br /> f(--Rj ii!'st. EPA/Olher <br /> E Stare <br /> a1 N 6. 3Z ! er <br /> EPA,/Olfter <br /> a 0 � c. EPF/Giber <br /> �� '� State <br /> u d. <br /> FiPA/Clher <br /> Additional F3ascriptians for Materials ListedA6ove I K. Handling Codes lar'.4'a:res''_isted=hove <br /> iiia DILY ABSOR OT <br /> ti's} d. <br /> 15. Specic.Hondling losfructions one Additional Information - i r <br /> c i24- Ys�ui M�i�ivY CONTACT: <br /> 2 t'f +LLi i n:C i 1€ER GrLFll ING & -,i rW-% R s31.i.fs L. 'D- <br /> r- <br /> 18. GENERATOR'S CERTIFICATION: I hereby declare the!the contents of this consignment are hilly and accurately'described aeove bycable inl—at;.nol o..d national` in name <br /> ment`regu.aKao iCed,packed, <br /> Londthe <br /> nd labeled,and are in all respects in proper condition For transport by h ghwey according to app <br /> `! ergs quantity genercicr,I certify That I have c program in plc"to reduce the volume and tax city i waste getm•ated!o the degree R have d fuwe lhr ro be economically <br /> and that 1 have selected 14+e practicable methoe aF treatment,slormge,or disposal currently wailacle to me which minimizes the present <br /> and fuwe th eat to uman health <br /> vironment;OR,if I am a small quantity generator,T have made u good faith effort to minimizemywastegeneranon and sefect me'aesl waste•ronagemant menc�d hat is <br /> ax me and that i can afford.C, ,b+onthypName l -� <br /> :?. rs orter 1 Ackr.awled emanf of R cele i of Materials m <br /> . Signal-ire <br /> f f tw�.na i goy�eor" <br /> w, ;I Frint� p Nar�se,1 _ ,, _ <br /> 'f N <br /> 5 <br /> 4 P <br /> r.. 0 <br /> IS " iter 2 ACKt1aw ed errant of Refeinl QF Materials' fr,enlh Day Year <br /> h <br /> l_s T Printed y d Noma vr Signature I l <br /> W- E 1 <br /> ua R <br /> 14. Discrepancy Indica.on Space _ <br /> A <br /> C <br /> E <br /> 2C, Faci';Iv 0-ner or Oorator Certification aF recoi t cf hazardous materials covered by this manifesr axceol as noted in Item ;_ Mourn Day Year <br /> - <br /> T Printed/Typed Name Signature 7 D <br /> � � r - j <br /> DO NOT 'WRIT "ELOW THIS LINE_ <br /> SC22A llidgtCC—2-, <br />