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A <br /> staff of;,dilanl.--Emiraan.+d Prora+san oe^sY See Instructions on back ge 6. Drpartmmn of Ta.ic Substvrees Com,, <br /> rm pproiid Qst!w.2030-0079([Aires 0.70.96) <br /> - M"Ark@ 0`."' Form d.dpaed for uw en Niro iT1pn /Pe'nner. S.craeento,Cow.A <br /> 1. Gene ow's US EPA ID No. Manifest Document No. 2. Pape I InformaNan N the shaded arum <br /> UNIFORM HAZARDOUSt I is nor required by Fedard lar. <br /> WASTE MANIFEST <br /> •. 7. G.rarotorLNaw and MoAkq Add- <br /> tWn A. Gewrerols Pha» (`,<;�` �.•>,.`; _ c{ : }/ - - <br /> m _ <br /> Q S. Trmsponer 1 Camf ..y Name 0. US EPA ID Number <br /> ` <br /> 8. US FPA ID Number <br /> Q7. Transposer 2 Company Name e <br /> U <br /> .� Q 10. US EPA ID Number - <br /> '•Z 9. Desigrarod Foeil'iy Name and Situ Address <br /> 0 C..y* <br /> W <br /> nQ 11.' cost '.. L•.:. 'Z.Si r1:. 71 �I s N <br /> o U rr 1 12. Cont.kers 17. Taal ;s 1A. Unit _ <br /> 11. LA DOT Desaipion C.I.,fmv Proper Shippmv Name,Hazard Clens,and ID Number) 1 No. T oumtity I Wt/Vol - _ <br /> i <br /> 3 G y . For r v E C f s J r.( •:; I ' I 1 1 c ' <br /> E <br /> m N b. :... <br /> Q R <br /> A <br /> m T C. <br /> z R I I I <br /> U d. <br /> 0 <br /> a <br /> W <br /> K <br /> Q <br /> Z <br /> 0 15. Spedd HandGrsg lbrrsdioru and Adddioral kformat;on <br /> F: -c, r4 _rtes J. n., <br /> Z _ .G..' a. "4 ill _ nsh�:- . .w. r:_ / t _i._ :. rj' .lt•: ` ---'---- <br /> W <br /> H <br /> 1Q GENERATOWS CFATIRCATION: I hereby d doom tlat the cam <br /> nes of des coroivmvrnnl are fully oat xcuralio described above by proper shipping name are are dosdfad, <br /> Q pocked,marked•and lubaled,and an in a0 remwn in proper c ndeim for Magas by highway according ro applicebb irearrtioral and rational gowmmeM regulaliva. <br /> :a <br /> U <br /> jH 1 am a Ivy@ quantity venerator.I cefHy that I hate a progmen in place io reduce the miumer and rozksy of waste venerated to the degree I have de rmksed to be <br /> i% erssrw:skdy practicable and that I have selected the proeicobk meetod of malme r,storage,or disposal carmn y vvailabk to me which minimizes the present and future <br /> n;OR,if I om a ana0 qumily germalar, I haw made a good faith effort nom emae:try wave generation and select the bast <br /> N cheat ro hanm fsaaNh and the ensironr:w <br /> wmfe *Kd.asa7able tome and Ilsat I can afford. - <br /> � `T .�- Month Day Yeoc <br /> 0 Pr "d�/Typed�No. I.0J <br /> c— <br /> Z T 17. Tra w neor 1-Adooledgementlof Receipt of Material, <br /> W Prknsd�../{T1yped Nm!e ( /� Month DaK, yaar- <br /> W 3 � "21 � 7'r t: .I%C k' <br /> W ` IL TrormporW 2 eF of MaNrsob <br /> T <br /> PnMd/Typed NSivn <br /> aas I na.e <br /> OMonth Deg Ysar <br /> E � <br /> E <br /> yWj 19. Discrepancy k kaiIk n Space <br /> U P <br /> A <br /> Z C <br /> I <br /> 20. F Oamer or C«ri&.liar of r of hazardous reatwiah rowed To madfest..cwt as noted in hem 19. <br /> Month Day Year <br /> :.. f 'rinsed/Typed Naw ISsp :olsrra <br /> r I <br /> DO NOT WRITE BELOW THIS UNE. <br /> v.u,,..,. res,eeecno o�ewc <br /> DTSC N722A (1/93) <br />