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.wle of tdduuu tudromnenlal Pralxbon Agency See Instructions on back of page 6. Depaament of Toa¢S.W.,-Ccnlral <br /> Furan AppmruJ OMB No.2050-0079(E,ida 9dD941 Sacramento,Callfomla <br /> rleu+e gnat a,rypa. Ford,dmi nod Inn uw on dib f12pilcld a'pewrdu. <br /> -- 1. Generator's US EPA ID No. Manilest Document No. 2. Papa I Information in the shaded.,.at <br /> UNIFORM HAZARDOUS is not required by Federol law. <br /> WASTE MANIFEST of I <br /> 7. Gwerutor's Name and Moiling Address A. $tale Manif"Docurnenl Nu be <br /> Y lL,t rkhili ks l fl Statel3aneloW,ID Q 5 5 8 71 <br /> r' , to r.dol I;U dYtKU7Ul.i.� HUAUs �TUCri CU7{ t:.i. � e ._._ .. <br /> 4. Genaumr's Phone <br /> cj 5. Trunsportm I Company Nama 6. US EPA ID Number C..,$tate TlarupoMrl ID 1. <br /> m o. Trutrporta9 Phew <br /> an <br /> 7. Tmmponnr 2 Company Name 8. US EPA ID Number E. Slate TramporNls ID <br /> iF. Transporw's Phone . <br /> 9. Dmignated Facility Name and Site Address 10. US EPA ID Number 0, $Taw Facility's IQ <br /> -1Z <br /> f p , oll.'IL.auri KtUYi;l.itit; (:kjRve� HFt><dlryt <br /> o <br /> 51.11 .u1rt1'd kkLUial;iY 1: ..,;1, `� <br /> 1T. . <br /> , s : . ' 12. Contained oto 1.1. Unit <br /> Il 1Z it US DOT Deuripti m(including Proper Shipping Name,Hazard Class,and ID Number) Na. T e Ouanti Wt/Vol I. Wade Number <br /> t. i= _�.— Stant_. <br /> ` tT 1Z3 <br /> )j3 EPA/Odwrl <br /> G %)su.rad Ilq:::1:(t/il:i:i 1J.:J 1 L lA ijU 111 (U1 L 6 ilu'1 P.11) ; s) k C l <br /> w E "' State - <br /> L. I Y <br /> E �tYj .J`(�". ! EPA/CIIMr <br /> v <br /> R <br /> ci A store <br /> O T <br /> O EPA/Odwr <br /> R <br /> Bs .. _ State <br /> Z <br /> EPA/Other <br /> U <br /> N K. Handling Codes far Wanes Usted Abow <br /> Z J. Additional D."dptiom for Mco dols Luted Abow -: - I. <br /> a. a'1 RF i•u n4 �'it'.. <br /> F AI '.. d.4 <br /> � I5. Special Handling Instrucfiana and Additional Information <br /> Z <br /> Z .a itK. Erll:xll;l:./CY CONTACT'- 1-800-874-4444 <br /> 1s111:Huk.LICY liL'Sl'uNSli: CUIiM TEL INC. 1-660—Z55-3524 <br /> x <br /> 1- IL <br /> 16. GENERATOR'S CERTIFI TI : I erebydeclare that a canbnh o the condgnmant are lolly and accurawly deuribad above by PI-ad shipping name and are dmsilie , <br /> Qpocked.,narked,and labeled,and ore in all respaen in proper eaddition for transport by highway aemrdi,sg a applicable federal,stale and internglional laws. <br /> U <br /> If am u IarBe quontiry gerwraloq I certify that I haw a program in place to reduce the volume and lozidty of waste gaMmted m the de,,. I have de manned to be <br /> ,ally practicable and that I hove wbctml the practicable m.O d of Treatment, smwge,or disposal currently available Io..whkhhf1s mi z dhr..., <br /> wselaand <br /> diheubest <br /> n. it 1 am-'moll ri ommator, I have mode a good faith ellod to minimize my generationan <br /> 1n tluaw'lo human 'me and the envirorajbl.t OR, quantity g <br /> aan mm,a a ant method Mol is available to me and that I can afford. Month Day Year <br /> Pd,ded/Typed Noma Signamn - ` <br /> y Y, <br /> U r 17. Tram anter 1 Acknowled emenl of Recei t of Materials <br /> MONK Day Year <br /> Z - - Si sure 1 <br /> P,h,lcd/Typal Noma 'y 9"^ / 1 J 1 <br /> w <br /> 0 18. Tram oiler 2 Acknowled a ant of Recei t of Matariak J Month Day Year <br /> us IP,,.Name $igmNra .� <br /> i <br /> Ll <br /> s 19. Dismeponay Indication Space N <br /> pERMi f 2r�C sq�rH <br /> Z C <br /> p0. Foa_h1y Owne or O orator Certilicotion of I.e.,t of hozordous mabriols cawred b this m nilea a eta poled in hem 19. Manrh Day Year <br /> T P,ha.J/Typed Name &grwwd <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> bits d011A III/Y11 Yv11ow, GENERATOR RETAINS <br />