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• unpmlmsm of(tea <br /> S '•'' <br /> Agency Toxic ub,pp(a�nCon visim <br /> Expires 9-30-88) x8acos ent liforv,a <br /> or use on site 12- itch t ewrfter. <br /> 1. Generator'sUs EPA ID No. Manifest 2, Page4' Information=phde�p0 S A � � Document No. of snot equ <br /> ES R } ^ //� A. Stele Manifest Document Number i <br /> Dnp A dress r / SI �07�/-r <br /> 117 _ <br /> B. State Generator's ID <br /> e <br /> 8.• US EPA ID Number C. State Transporter's ID Q 7 <br /> ,t ILLILV D. Transporter's Phone 8 0 4+-lj4){y <br /> e 8. US EPA ID Number E. State Transporter <br /> 's ID <br /> Transporter'.Phone ' ` <br /> d Site Address 10. US'EPA ID Number G, State Facility's ID <br /> ice CD08 1111166 6 <br /> H, Facility's Phone <br /> 51363 CAD 0 3 1 6 6 7 b ( 'r 0. 4 a '14. <br /> 12. Containers '13. Total l <br /> Quantity Unit waste Na. <br /> ing proper Snipping Name,Hazard Class,and ID Number) No. Type J Wt/Vo <br /> State <br /> 101 j <br /> r <br /> copmu8' T➢LS G1QUID` :NA 1EPA/B{{her270 2 f J G <br /> stats. <br /> EPA/Other <br /> 'state <br /> I'- EP,AYOthe <br /> State <br /> .1' EPA/Other - <br /> r <br /> atterials Listed Above ) K. Haadling Codes to(, antes Listed Above <br /> *. a. _ b <br /> k'2 PX �, o e. <br /> a ' <br /> a and Additional Information S.- s <br /> ATION: 'I hereby declare that the contents of this consignment are)ully and accurately described above by proper shippumg <br /> packed, marked, and labeled, and are in all respects in properIcgndition for transport by highway according to applicaibie <br /> government regulations. F ; <br /> nerator, I certify that I have a program in place to reduce the volume and toxidity of waste generated to the degree I halie <br /> ically practicable and that I have selected the practicable method of Jheatment)storage, or disposal currently available M <br /> resent and future threat to human health and the environment;OR, if I am a small quantity generator, I have made a gco: <br /> waste generation and select the hgst.%ILete management method that is available to me and that I can afford. <br /> Sig 'uie Month Day Year <br /> el S1 <br /> ment of Receipt of Materials <br /> .Signature Month Dar /ear <br /> ment of Receipt of Materiels <br /> 'Signature - - Month Use 'ear <br /> i <br /> reification of receipt of hazard uematerials covered by this manifest except as noted in Item 19. <br /> 'I S <br /> Month Ds. <br /> ignature <br /> sy _ <br /> Gg INST UCTJONS ON THE E::A <br />