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Staley((Colif.nd.—Envirannesh of Protection Agency <br /> Fc:n;Ipproved OMB No.2050-0039(Expire,9.30.99) See Instructions on back OIfa 6. Department of Toxic Substances Control <br /> Pierre print or type. Form designed kr use on elib(11-pikh(ty r. <br /> SocromeMe,Calikrnio <br /> ' 1. Generotar's.US EPA ID No. Manifest Document No. 2. Page 1 InFormoths.d the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low. <br /> WASTE MANIFEST �I T•1 ! 181111181 q —71 217 11 1of <br /> 3 Generator's Name and Mailing Address r TRACT (, A State Manifest D.cu nt Number. <br /> 1r1' sv.v i"' .LRAC �1''.eSt, NIPAS�.ir <br /> tdt# I.Li LT, iSs9.J � t�.yl :��s tR> x, ' <br /> O V.0"m� ..r54+ df'x`vii . - B. Stat G ...tors 10 <br /> v`Gi 4Irdhr s Pltdne 1 1 `: 3IK'> <br /> w 5. Transporter 1 ComposAy Ham- 6. US EPA ID Number C. Stete T nsporter's ID[Reserved. <br /> h <br /> m rR���i <br /> o R1111ll�r�r�RRNSRMATION y p D. Transporter's.Phona <br /> m T, ranipdi' Co'm'pddy Nb'e'" 8'.0 'EPA IDN a,6.rr "' E. Stat.T ansparter's ID <br /> �_s F. Transporter s Phone <br /> Q <br /> .,.V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> +3a }}��i//5wf ap,��T �t +H A xv�rY��qpV n� r�,v{3 <br /> wZ RMIC 9N IROW1y{�e,"Alx `f2(_'f1A4/Ai,Jsy.ik1O H. Facility',Phene <br /> [G <br /> '7'O GtK1Y YY3t 3sAik9dF _ <br /> r '� .'T P T` a <br /> VQ -- . 12. Containers 13. Total 14. Unit <br /> �V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T e Ouonpit/ Wt/Vol I. Wc,to Number <br /> Za >e State <br /> «-Tre ii.r'.tr9N"iBIX, LIQ)T IS, a�1.+�t-,J S:{{a1i:y�yyC7,,p,IA$}t AND — <br /> AIM KESSs.?1J.l10, a y C�11149ri £'i Isv s E EPA/Other <br /> 3 c t ey. y <br /> oN b. 5t.t. <br /> m E EPA/Other <br /> Nr R <br /> v A c. - .sore <br /> o T <br /> O 'EPA/Other <br /> R <br /> w d. State <br /> wZ <br /> , EPA/Other <br /> V ' <br /> N J Addit,c..l Descr,ptiens for M.ten.k Listed.Above K�,Iipndl ng Codesf rWostes Listed Ahove <br /> 0 #S ,tx4 2ft3(xS(2� ('�0)LjS!:a al,_ ldt J14 L<711T­111 4 t t, <br /> w K "ks ek <br /> 0 15. Special Handl eg Instrucllons and Additional Information. CH3E8l"t.� WSAw R{ RI.Y 4k'. <br /> ISL_ <br /> Z 24 HOUR Pk'ZI1 4asXN Y {XjA;4r.'E':UM-PffTI, P r"«$ 19f..AX? 800MI—UY00 " ?c;. <br /> wa"1Ia P i'=TwT �'x'CfmTtT.xc, & k*FxaI6'3mr, 1..31TI: .I_1).: ?.)--6? <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this cansignmeN are Fully and accurately described o6ove by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition For transport 6y highway according.to applicable international and notional government regulations. <br /> f If I am a large quontiy 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 b s economically <br /> a- practicable and thatI 6ma selected practicable racticable method of treatment,storage,or disposal currently mailable to me which minimizes the present and Future threat to.human 6eolth <br /> and the,to <br /> and t.at I if I am a small quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> O available la me and that can afford. ....._....__ <br /> } Printed/TypedNama sig lura - Month Day Year <br /> 17. Trans otter 1 Acknowledemenl of Receipt of Matarioli ; "s 11 <br /> Ur It <br /> ad 1 -Printed/Typed Name 'Signature - G7 Mo+7 Day pYear <br /> w v '�zCf4'!Ji '1�6 fir." ,✓i f W <br /> w 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> W E <br /> Q R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> E <br /> 1 20. Facility Own for Certification of recei 1 of hazardous materials cosered by this manifes. in Item 19. <br /> T Prinlad/ oma Signature Manch Day Year <br /> Y CSr.t ,. �' 7 Z S" v 3 <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Green: TRANSPORTER RETAINS <br />