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4,Ste(�a q,(pq .116th <br /> elle r( ..• CY ' gplrtmant o/HaaflllBaMcea <br /> j'Fp 1WPfo1' 6.20,_ roa 9x3U: �) yj " F oxide utietflt2'ei'.QunTrblAhHeba <br /> .�p� uepV�rl� ell/osnlq J <br /> 51 <br /> -Pbsea"print of typa't ( deeep use ort sINaXp writer)=K'y.;),�l . Yr A. <br /> UNIF 11e_ HA 'A DOUS' 1. Generglo s US EPAID NO <br /> �� '�b i dK.Atanhaat 2.;Pags 1 1nlo metro bhgiluda'i ere s, <br /> H.• OOb�it _ Document 40.1I.not requlrod by Federal law. <br /> �p Wp(s :M NI EST <br /> — 3. Generator' R I <br /> Nerfe and Mailing Address i �e �l.1/ ' A. State Mani/eat DocumenfNumber <br /> 951161 7 <br /> to <br /> f7��3�/�✓�e _ B. State Genera <br /> �Aor'sW <br /> �? e <br /> 4. Generator's Phone(�.1263 S21 Z <br /> D - fi.-Trensportar 1 Company Name - e. - US EPA ID Number C. State Transporter's to .. <br /> n <br /> ` D.Transporter's P rte <br /> 8, US EPA ID Number E. St ateTransporter's ID z58Z -G17z,>'83 _ <br /> v 7. Transporter 2 Company Name <br /> $ LvoE2 772!/ t'/Nv C 0 3 3 F. Trenspor er'a Phone /S 4,x, -Z3 9G <br /> 9. Designated Facility Name and Site Address "10. 'US EPA ID Number � State Facility's ID <br /> 6• t <br /> v 3S�s/cL-4 Si�yuvE",�lgd rL Facility's 1`110114) <br /> 12. Containers 1'3. Total 14. 1. - <br /> Quantiy Unit Waste No. <br /> a. 11.US DOT Description(Including Proper Shipping Name,Hazard Clava.and ID Number) No. Type Wt/Vol <br /> < p � . ��. � I',Y State <br /> _ �. <br /> _ E rAIA -VFM9 46"7ZW- J"V OIrP• _ EP I her <br /> F N / t7 So/L / d / <br /> . I / �( State <br /> E b <br /> AMECD _ FPAIOIher . <br /> v O r0pi^ State <br /> z. <br /> 8 r MAfLED EPA/Otho r <br /> m <br /> w d. <br /> 07 J Additional Derons for Mstenab Listed Above? s i v x c vWC Haa0tln0-r'odea tae a „ <br /> O "iE, t ';^ <br /> Ir <br /> O . . - <br /> H18. Special Handling Instructions and Additional Infonnalion <br /> Z pg,P -�Po: rivE f^.So7Xi�v6 _�d. 'r rs .�.vr�ciPAiz1.:l�nc2 4ha7 <br /> - <br /> "' co.�J"rh'os� .r��7s�.e�s' .O/+.�.vG u�,tyca.9.a,✓G. :/Y�ie ,P�i.@�zsPS drJ�f <br /> J <br /> U le. - - <br /> GENERATOR'S CERTIFICATION: I hereby declare that MO VOntents of this consignment aretuity and accurately described above by proper shipping name <br /> �. and are classed,packed,marked,and labeled,and are in all respects In proper cond8ion for transport by hlphway according to applicable imemational and <br /> d national government regulations. _ - - <br /> W I cern that I have e program in lace to reduce the volume and toxicity of waste generatetl to the degree I have determined <br /> 2 N 1 em a large quantity generator, ty P oa P po g W disposal currently avallable to me which minimizes the <br /> to be economically practicable and that I have selected the practicable method of treatment,storage, <br /> O m <br /> 0 present and future threat to human health and the environment;OR,it I am a small quantity generator. <br /> I have made a good faith effort to minimize my wa.ate <br /> - <br /> O generation and select the best wlate management method that Is available to me and that 1 can afford. <br /> w Printed/Typed Name Signature Month - Day Year : <br /> 0 <br /> .W ' r <br /> wT 17. Transporter t Acknowledgement of Receipt of Materials <br /> Z R Signature - Month Day Year <br /> 4 A Printed/Typed Name <br /> N <br /> LLO .S .. <br /> UJ O 1& Transporter 2 Acknowledgement of Receipt of Materials _ <br /> T Printed/Typed Nanta 519 - re Monfh Day r_ <br /> z E /✓ 1/rmlelg <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Signature Month Day Year <br /> y Printed/Typed Name <br /> cp� rq c . ` t. ! o oEq <br /> DHS 8022 A(1188) - - - Do Not Write'Below This Line ` ,t <br /> EPA 8700-22 14, ,' <br /> (Rev.9.88)Previous edition$are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />