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for py�prpo'o�i p11i8 ir, �di k r <br /> e Na.RAS 39(Expires 9 3(I1ggl ' <br /> Phase"print�rype Forms S@9 illihuttiOn3 on ;.}t_t s <br /> 8 _ far use or f 1 pfkhJ tyX N b6ck of pang�. <br /> losz 60 <br /> Depanrnent gf 7muc Subajo;rgry Caeirt <br /> ' UNIFORM HAZARD rarors US EPA ID Na. -- — soc.a,n.nb,c; iorrrp <br /> Mani rxument No. <br /> WASTE MM n p 2. Page 1 lnFarraarianinthrsfwded R <br /> r C Q �.." 'r. 3 V 1 .6 '7 Arras <br /> r r1 lG t i- { is not required by Frderd'�arJ, F <br /> and airing ! or _; r <br /> MAI <br /> in ' '4. Generator's Rhona('' 9� <br /> ri`.- Le) 5. Transporter I Compare Name <br /> Y 6. US EPA ID Number J <br /> t `- o £cdh3gY Gr lal�lthssbllaglt0 <br /> 3ame <br /> �pp <br /> .x �m .' 982Q7R . <br /> itta <br /> A D Num <br /> ' Q 9L Rlivna Fd iiilyN�me and Sitetiddress ' <br /> _ 10..US EPA ID Number _ <br /> CMZ 255P� RR <br /> � � r BLVD <br /> h-O • �ClAARi�Nt] <br /> a 946631 2- <br /> 'I I' US DOT Descdption(including �* <br /> r E eye B {Shrpping Name.F{a=grd Class,ontl ID Number 12. Conloiners <br /> I '13. Total - 14. Unit <br /> No.of T' QuanH WI/Val <br /> E TAN <br /> TY <br /> NC3�t-RGRA H. US.WASTE SCOLJE) <br /> Q N ~bi R�. 0 0 P' <br /> r _ <br /> k_ <br /> o i . <br /> ';ago R" <br /> x :LU _ d <br /> Z <br /> t,ZJ.,, <br /> O I <br /> a <br /> FA <br /> SpecialHandling fnsFiudion�qnd gadirionalinformalign <br /> w Wear . e protociave' i r <br /> ., <br /> Z. �pnte+>Et W11I�8 hailld1 tg, `' <br /> t 24 M6r4m' Warorib,or vnf ", ire approxil7><att�. Ekt3�s i Ti , r x <br /> M4 to how ntlml�er •. Q •. p ' <br /> ` w r4 I`�pFdt;@IIIl1Ci /C1 t g I/�+j�j///7{I fL/!� �. `� !�(p <br /> ' � ' Sir <br /> 16 GENERATOR'S CERTIFICATION 1 b�reby declare that the contents of this coni nment ora fully and Accu ' descried r�Y tEa� <br /> marked, <br /> and labeled,and bra In allaespech in proper condition for hanapor!by Ftighway ac�ordi po �' shipping name and are dass,F•ied,`• <br /> 1 i' ng reable m and nations gowmmPnt regufahans <br /> y _ r, <br /> I t If J am a large qugnit generator cerci thud have d ram rn F ' <br /> <4 ` + fy p place ro reduce the volume and Toxrcdy of genarated to the res I have <br /> deMmi �' k-' �i• <br /> t'h Practicable and that I have_Select <br /> practica6le'melhad of traat�rent,srorogs;or disposal currently awv lable to ms.whicb minimizes a present and Future threat to' <br /> and the environmenTr ORj if l am gsnall quonlily ger br;1 lwvb'rwde�o <br /> r l <br /> 0 available is me and thai i Can aHnr¢ g i6irh effort to minimize,rriy waste"gu�eratigg and select the but waste irwnogement mrdwd16g1 h Ix <br /> , <br /> IN <br /> rh + Signatyrss``,��� � Month' /Year s� <br /> Z /w/J Day 4�j <br /> T'` 17. Trans r l vcknawlsd ement of Recei t of.Materia s k <br /> �.. <br /> a 4C R _ <br /> to _A PrinFad/7yped Nom <br /> r. <br /> N, i <br /> fi "6 <br /> Month <br /> �'f•' . I �t 4a� �, :Day �raYtwqr�.,: <br /> �}.u. 0 18:Trae� 'rter 2 Acknov l is ement gF ecei gF Matenafs – <br /> z f Prin. Name. M <br /> ✓ 'V�f E Signaiun' Month �u <br /> h r qN <br /> V F 19 Discrepancy Indication Space <br /> L z A C <br /> { N; rs <br /> ,$a�h �•t�r� t,� •raj <br /> - I 20. Fault Owner or- <br /> rotor Cerhfr "'on of rewi 01h rdous materials covered this manifest excs tat noted in Item 19. <br /> ru arY u Y. PAn /TName+9�.-:�" `, t , Signaiur <br /> 'Mon <br /> r DOt <br /> NOT.1NRIT� BEI,QW'THIS LINE E <br /> :Di$ J022A[4/?7) I 3 �� "i3F <br /> .x <br /> f� EPA 8700-422 �y Al <br /> 4, 5 a i�V_ J <br />: s y Wyk Yellow: GENERATOR'WAM.: q <br />