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' �'t r' R�ransriar i"Phone - <br /> ”' s y1ar F cili(y�mm���d <br /> site US EPA ID Number j� �k a FacdltYs 1 f „ tN• „ . <br />.'�' Q �� I� S)NrigtpL STRIE 9 �, ,,,� �,..• r�',�,4 4�; ���.��Jf ;r�Si�� Y <br /> .Mr .r lett N A.. y �i �{r •}µ 1 t rvlr t '�'r y7 <br /> \ 1 s 7 , <br /> .{,{•;' - +.ts,., F dr✓`4. , "i.v°.I. i1 z:,r ;{ pcciliV*Phone <br /> pC <br /> J O R2lNIL`FfO CO., <br /> J. <br /> OR)^ h,� CA Si37S2 j 3;i D �9 8 IS '!! 8.,•�jt ! � fu rr � Oils,dS1 098 <br /> rr Q 11. US DOT Desa1 includin Pro r ShippingName,Hazard Class,ono IC Num �S" � 12' Containers �13.,Total 14. Unit ? f <br /> f [ttr No T ° Quantity Wt/Vol 1 4 fVaste Numhsr <br /> ` <br /> ';� S��r(•''tlt�{n`-��.r4 •���I1�' Y.7 �was.a�i STI I a°}, - " + j� �' t n �• � ° . ;rtC� .�•. .f11��, t ��i3�:�iS��v. . - i�' <br /> ,�' G' '}'i„"r: �S t++�;s;,L�F �l : ra",''�.',.t.'' 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GENERATOR'S CERTIFICATION: thereby dedaro that the contents of this consignment are fully and acture described above propprflltip ing name and oro dautfied 3.i <br /> g taly �sy <br /> marked,and labeled,and aro in all ns m proper condition For hansport by highway according ro applimbla i�tarnghonal , nation government regulations t4 <br /> f i °�*�r !. 't •, A`.f nl '4.y a1rr.-,: I r. I .+rf. ::R1��,t!:il�. <br /> R I am d rye quantify generator tsati t 1 a p ram m place to reduce the volume and fowc 1y of wash geneiahsd to the degree I lYave determined ro bs aconomt <br /> ,practicable and ihat,l have selected the prochcobls method of heahnent,srorage,or disposal currently avaifable_to me wi+ic}t minimizes the present and Future threot to human <br /> ethod that is heohh, 's <br /> ;S, and the ermronment OR,Jf I om a sena II quanhly generator,I have made o good faith eFfort to mtmmtze my warts enemtion aixF select the best waste management m - <br /> d gvmlabb bMast(and tfwt I can afford .,<'.�''r�"/7fiS"ic'ly4` :'.' � d,' ' n' 'rhr(1��� moi! 1i � i�a���i't>!trY�lit-'vrror'rRK•►� ?! <br /> Printed a -1 w rtI Signature + +tiUtii a > W: MonthJ� Day V <br /> Vi <br /> :T 17. Transporter 1 Acknowled ement of Receipt of Materials r r <br /> Prin yped Name `.$ :E r�'*. Signature ;1;�'1.s } t. 52r Month ".'; Day .':Lxear - <br /> LU <br /> _r 18. Transporfer 2 Acknowled ementof Recei t of Matedois <br /> PnnNd/T1rped <br /> in Day Year <br /> ffn 8 'S ll 01 Yti� N.3 re l ' ti• +lY i��Y s is 1 <br /> Month ' r <br /> OisereponryJn�dication 5paoe <br /> �,iJ•irL(T.�•v.•�yrr,}1 1 �f 1 S / S aJ IfyyR' le a[!'Ca + f.4]r:r fT T t+o. �J � �t�,,y,�a tq'+ r i <br /> , ./, S �•'IPS'�`�yt. �dr• of '.�{ 't �lhl �.� j '� J-. �yl Ki�•�rs..t r •A� •+t 5Ad 't+ ^I 1�tPsD�s�,��¢`'�f�� �,_. <br /> :� �'tIf!♦, yA'..f;t � � 111'��'� y�3.rd:1 trc�i'' [;-�� t- :•D ° Tth �':` ' ', , ¢}i�fCIt hl�.� r�}�,�. <br /> •''S� ..p:v�. N,. ... , :: 7•' `�.,. ,.�i� .,.k"a r _" . :..,af <br /> + Y <br /> i 20. Focili O Owner or O Certificati recsi t azar u materials covered b t s ifest ext t fedi <br /> Ay r j PnNed/Typed Name �'14i�lli .�.c Signature ,` ," i Month„ ": Day :Year <br /> ,0 Q��( <br /> V.!r ri<. f .} .,�• iM- f St! <br /> r c•lk {" f;i .� �, ,t O NOT WR E BELOW TO dk <br /> COP�.3�'SGENERA1bR. <br /> to 4N-V" Iwo) if{io�ordous woe/er�QC fiEpexf bSff �ffOfa�r <br /> feted this co n }o'�TSC.wri ni $90 " <br /> }.ErPA 8700-22 • �: r e}�rle}P4 ' e�i,• t�ti�a ' �l �r ? 1a��. �t �� t, .Py a <br /> .. c1, •.a �'V.i,y �'rT"'` r. tit-i�, l-r.:. 1,, t•Y.,.:1,ir. �:,' ..- - 1 .r . <br />