Laserfiche WebLink
$t trio—Environmental Protection A...ey <br /> Fc tri Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of 6. D ,Fartmem of Toxic Substances Control <br /> P .print or type. Form dmi med{or use on elite(12,Mch) der. Sacramento,California <br /> UNIFORM HAZARDOUS 1, Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFESTIs not required by Federal low. <br /> of <br /> 3. Generator's Name and Mailing Address -A.'j5tofeJMnrfaE1'DeeansyR Nurnb n"yk.»..C e4 - <br /> n tri /efTrvSparETATi441 <br /> F Gd' <br /> 4s i P ane � Ay <br /> CO <br /> d5. Transporter 1 Company Name 6. US EPA ID Number Y <br /> f err . <br /> jD <br /> 7. Tronsportm 2 Company Name S. US EPA ID Number 'E,.4mate b ;?1Dgz -' +� ti <br /> Q fed,; <br /> U <br /> j Z D n� dFosiliy Nx rr:/e� d Site,Add <br /> ee,, JIL..US Number tC%' teFoaWy}TD,.' y_. • ' c '.+ <br /> OlloTT�.LUit.�.✓G' sG/r� v = <br /> LL }! 'Frf/sphane' y <br /> Q a4. <br /> U 12. Containers 13. Total 14 Unit ¢ s +F <br /> 3.Z 11. US DOT Description(including Proper Shipping Nome,Hazard Gass,and ID Number) No. T (.\saMAy Wt/Vol ,Nf^. r. <br /> 3 G 44 HAZArSCIPdS <br /> c iE <br /> w N b. <br /> w E -a tr`+nntrdaf r d +'- <br /> N R ;EPA%Odie• i ", *.°,• <br /> o<OP 0 <br /> - >its%'t??s•.w�,.'.r#f.'•�.s•!",��`��.r. <br /> T c' ate el't' <br /> R u <br /> w ' 'Y-- <br /> Z d. <br /> U EP�'Ar��yOflser a3 f' :: <br /> N <br /> Z x ddrhorwl;.Deurrpfarn kr alsaLhtedi '-`y£" h�lE..� .E ' . ''s a ^,Ur y,rr�i;.,?�r K r Hor'dhng Cw3es forlYasles Lssted:Above i� ,t� <br /> Ow a <br /> Z <br /> O 15. Special Handing Instructions and Additional Information <br /> Z <br /> Z <br /> 16. GENERATOR'S CERTIFICATION: I hereby deoltne that the Antersts of this consignment are fully and accurately described o ve by proper shipping name and ore classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> If I our a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently avoiloble to me which minimizes the present and future <br /> C threat to Kumon health and the environment;OR, M I am a small quantity ganeralor, I have made a good faith effort to minimize my waste generation and select the best <br /> west.management method that is available to me and that 1 can afford. <br /> Printe/Typed Navme ; Sig mre _ / Month Day or <br /> . _ r/,-6, <br /> > / { / �fr✓ _ I T-d <br /> Zi 17. Transporter 1 Acknowle8 ement of Receipt of Materials <br /> w ♦ Pdn1e me Sig r< s M rrth or <br /> K S <br /> LL' r <br /> �, 0 78. Turns orter 2 Acknowled emenl of ecei t of Materials <br /> LL' T Printed/Typed Name SignaNre Month Day Year <br /> LLE <br /> O <br /> W 19. Discrepancy Indication Space <br /> N <br /> Q 'F <br /> U A <br /> C <br /> L <br /> l 20. F.cility Owner or Oaerora,Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> TPrinted/Typed Name - Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (9/93) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />