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/41FORM HAZARDOUS rotor's US EPA lD No Manifest DoEument N1. v
<br /> ' WASTE,MANIFESTit) / / a� is not required 6y Fedora)]aw I
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<br /> JA 10 19 19 4 ', l�
<br /> W{°US COT Description lincluding Proper Shipping Name,Hazard Cfass and(D Number) 12 Containers 13 Total 1A une �,y.d>Ly.
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<br /> -Y4 AdditiMbil Poscriptions for Materials listed Above s f
<br /> ��yp_7jS K andlmg Codes for Woslss C,sted Above K {a�
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<br /> 15{Special Handling Instructions and Additional InformationGLOVES
<br /> r"` `` "EMERGeNCY RHONE 219-"7.8857 � �C I�?L)N �Ci,
<br /> f d' GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described obove by proper shipping name and are classified,packed,
<br /> marked,and labeled,and are in oil respects in proper condition for transport y highway according to appficable international and national government regulchons,`-
<br /> {' t
<br /> IF I am a large quantity generator I certify}hot 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to bet economicallyy
<br /> practicable and that[love selected rhe practicabfe method of treatment storage or disposal currently available to me which minimizes the present and future thr"sal to human health
<br /> and the environment,OR if I amC_a small quantity generator I haveymade a good faith effort to minimize my waste generation and select the bas!waste rnanogement method that is
<br /> „i "t,x trvelfabld to i o and
<br /> I_
<br /> P ted ypad /. ~/r�r r w.1 {Sig �ure, month i
<br /> Day Year
<br /> iC� " 1 ' +
<br /> T 17 Trans arter 1 Acknowled ementef Recet toFMoterials
<br /> R
<br /> N ed/Typed Na nature "� T month /Cay Year
<br /> ti 18 Trans rter 2 Acknowle emsnt of Receipt of Materials
<br /> R
<br /> Printed/Typed Naafis_'t r I 7 t �t Signature 'r 7
<br /> E Month„ Day Year
<br /> j19 Discrepancy Indication Space - f •t ? i} {' r 1
<br /> r /Dl F �'r�.,ti , , d.' F1 '~a ' • ` rt `�^ "iy.` ^,4- } ; `
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<br /> r aja, -20 ;Ji Owner or operator Certifrcatron of races t of hazardous matenaft covered b this'manifest este t as:bled in Item 19 i 1
<br /> r t "Prinfea ype dme a.� r _,c.. r, - 4' A Ftaifth.dY ,a Year l^ 11
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<br /> DO NOT WRITE BELOW THIS UNE.
<br />)TSC 802M{I/99)
<br /> PA 8706-22 Yellow GENERATOR RETAINS
<br /> THANK
<br /> you
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