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lsP.O; me daadzsa 1EICHERT AND SON 11009 <br /> SIep 9KaG{amia—Enrironmenml PmtecEen Agan, <br /> Po.�at Ap r'ed OME Na_205IWasP(6piimn 9-3499{ See lnstruclions on back of(.�6. Drpartm�,l al To-ie s„h.ianrm Cent'd <br /> p bpe, yrm da.:ga.d Ier nae an dik I12•pbdd rypewr;br. scemmai m,C.1.6.va <br /> 1. Gmeralarc U$EPA ID Me Mon.l9 tD.Gumenf N9. 2- Pogo 1 Information in Ihc.h.'6: artq: <br /> UNIFORM HAYARDOUS Favor regaimd by Fedeml lm-.. <br /> WASTE MANIFEST .! <br /> a. Gammie/s Nan.and Melling Address 'T I <br /> .103 Alo�erX S7 a rt V q F,II <br /> • .. bra p�I 1 r ro,u , cR 4sZ�.� hM � � �� 'R i II � I , N� I h b N U � �hl <br /> N 5. Tranlp9rmr 1 Company Name E. V$EPA ID Namher - III �V. E <br /> p �Ut�IFWI><IWCM V1LyLrltew� •��� IN IE <br /> 7. &itriii .2 C.npany Noma S. USEPA 10 Numhx a'I �� � I�,�tIR <br /> It1�11111IIN 11 <br /> V 9, Design+Ied Fa i6ty Nome and Site Addren 10. US EPA ID Numbn <br /> BMW OL <br /> i o sm 5�.4+W'R N <br /> bKokiiCAGM m RUM III a <br /> 12. C9nammrs 13. Tara. u. u+a II .pI <br /> 11. US DOT DimorAphm.Uncluding Fmper Shipp,Nome,Hm ord(]ass,and ID Num6erl No. T a - Qu9miry wt/V01 � G I 14�'"III <br /> Q)17 W/"fl rural <br /> 33 � HOP3�RA:A:S" <br /> Jill <br /> IN 11h, <br /> o T ` iI1RT'I' 1 jil l li..-hi�tj rp <br /> o �Illlii����iW <br /> R x: <br /> It- <br /> lti�!N! tilh <br /> VI <br /> EFA Aid, 1 I"I "I All, it <br /> z19. SI i+l Noodling l nsnusBans and A&Iv.nd lnlarmahon <br /> a24 N.er Em�r�ency R +» e TaSoaF ar^ .:C;1L 4�EG 4 BCSi,23f#� ylvglav:8 7-350q0 <br /> z Of M T71 WENN PROTMVE EQlf"MEA"i res tl T}CT 4�r+3773!3 <br /> Y \ <br /> 1 16. GENERATOR'S C9nIF1GAnaN: llmraby dadom that tha cnnlenn of rhia runsignmenl ora h+lly undamrvlef�.dmcejbed aha•.�hy prapar sMp�in9 nomn and arc cieuAid,padmd, <br /> Q mcni and 1.66d.and am in''�m1tl rc:pech in pmper mndifion Ior banipon W hlghn ar oamding to app Iwhlel''nbmalionnl and nagena ga•ammenr mgulariens. <br /> V 1 <br /> r IF I o I—W gcanrlty gommmr,I aertIfy 11hot I have a Piro mm in 01040 W mduce the vol me mod 1.4iciiy of waste gan+voted m the degme ha.a danrnined ro be economi.olly <br /> P—Iim61a and Thal I h odor®d Ih.ymitscii method aF trmtmeni,ebmge,or di-1-1-1 nNy avails NO ro me which minimizes 164 pr mY and lunim Ihmat to humrn h.a111t <br /> and 160 emimnmenc OR.if I a 1.011 gsam;ry g.nemlai, Igoe mod.a goad faith effy�ininua m9 wast+geman0on and select dIe bexl wo:tc management n4elhad dmr i <br /> available ho me and tool I con olFord. <br /> } Firm ypw Nome S:gna t ` 1 // '1 D, Year <br /> Z <br /> T( 1 vans orlcr 1 Ackn a em9el o .i I 0 M.Iffini r mandr Da Your <br /> rY F. Malad/Tryed Name 546..'ey <br /> 5 <br /> w p <br /> a /E. Tmm r 2 omen I of Mmerials <br /> 0' .T M1inted/Typed Name 3gmuna Month DL Y+ar <br /> E <br /> 19. Dlserapanry lmlimNan Spaea <br /> y� F <br /> — A <br /> C <br /> M. Facil' OWm oro mmr Cemigcrr;on oL rws+i rofhazardausm Ierials w•emd Ihis manilesl ante 195 nomd in lmm 19, r <br /> T mntadlTypad Namc EignaNre MarMin day Year <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISE B022A IA/971 Yell.— CENCRATGR RETAINS <br /> EPA RM22 <br />