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Iw`�:nhlnrnm—rinnitn non Wnllnrn Aonnry � Dnpanm enl dl Health S0lvr4oa <br /> I round 01.10 Na.2050-0009(Ego-en,9.00.9 U � Toaic SubslenLes ribnllPl Givtmar <br /> ,..ml nr tvde. (Form designed for Yfa on ehln 07P0101401-11"PSaceamenlo,Celitmnu <br /> .` U P1IFGRM WA;>:AI�DQUGS 1. Generator s US EPA 10 No I Mamfesl 2. P:Q Informs hon in the 7heded sites <br /> WASTE MANIFEST C a,0( IZIf�7 00"o'o° / / <br /> not raouned a <br /> dl Is Federal late <br /> I.11:/enermor's r1mmn.nn Ma- <br /> n I Ad�rnns r! A. Slate ManPlosioo131,0 S 0 <br /> f Cry l M1 <br /> IS/ <br /> S/&A L /S 44,0 f" n <br /> B. Stale Generof's 10 <br /> ,.. Gah-1�6i(A B1 PhUne( J`•ry 7� I`7 '1T'T �.) I I <br /> 5. Trgn parlor I C`�mpan Name ~--� 6 UQS EPA ID Numbar'Q Q C, Stale rransporler's <br /> � �N .11 -1 I>�IJ I2/l Z` 1� I Q: Transporeei a Phone a 3 <br /> -7. Transporter 2 Company Name 8. US EPA 10 Numbar E. Slate Traniponer'a IQ <br /> F, Tranaponer'o Phone <br /> 9 DesirInaind Facility Nnme and Site Address t0. US EPA ID Number G. State FaclGly's ID <br /> r IF,:eICK-�a,V Inc, iCaA0, pIY,0,6Gl.319 <br /> _57_5- n` n e- Q1.11!_7 H.Facility's Phone <br /> 1 2� rS- <br /> r 12.Comainers 10. Total 11. 1. <br /> Fat I. US DOT Doscrrplion Rncluding Proper Shipping Name.Heterd Class.and ID Number) Ovanhty Unit Walt.No, <br /> No. Type WI1VPt <br /> ° tt r,S T-F E!M F7-'? TAA!(C /VCAJ -SCR Sim", <br /> a o �Tr 0� P state <br /> Slala <br /> L__LJ_L_L_ EPAI Othaf <br /> T7 <br /> -` Sle1e <br /> r I EPA701har <br /> T State <br /> FMC11161 <br /> ddiiio.ed Doscripti0ns for Materials Listed Above K.Handling Codes for Waat67 Listed Above <br /> ' jA wCTl� DAY �CE '0 <br /> C. d. <br /> 15.SpaclM tinndlmq MalruClrons and Additional Infcrmalion <br /> t:ap yWM <br /> .� GENERATOR'S CERTIFICATION: I hemby declare that the Contents of this consignment are Tully antl accuralely described above by proper shipping name <br /> and aro elassifiod.packed,narked,and labeled.and are in el)respects in prance condition for Iranspon by highway according In applicable inlemationei and <br /> f nntionel govarnmont regulations. <br /> + <br /> it 1 nm a large quenfily generator.I cerlily Ibnt I have a program in place to raduce the volume and tar icily of waste genefefed to the degree I have determined . <br /> tc to be Orono icnlly practicable and that i have sel°Cled the PraChcabre method of Irestmenl,sloraga,or disposal currenity available to me which minirnitaa the <br /> "n p,eannt and loran threat to human heallh and the environment OR.it I am a small quantity gene lot.I have made a good lailh eltort to minlmixa MY waste <br /> gtnarelibn and select the best waste management melhod that is available 10 me 941,41 1 can afford. <br /> llolfad/Typed[fame Signalure Montt) DAY year <br /> t 17. Trnnspbner I ACknowledgamenl at RaCelpl of Mal■ftala <br /> t Pnnlnd TIed Ndms Slgnaru+ Maath Dry Year <br /> y 10, Ttanrparler 2 Acknowlodgom■nl a'Reee-PI dl 164e1n11nre <br /> (. <br /> f <br /> Pnnrode Iypnd Nemo Signature <br /> Monro Day Year <br /> 1't° <br /> a QinCrnpnncylndiCdhen Spars <br /> S.._.__.. ......_...__ <br /> 1 22, rnId.ly Qwnnr of Vpn,nrne t:nlllhCnh0n of 10Cer01 of 11n1n1e0u1 matehats co,eerr•d by Itus mandest■xctot as n d l Item 19. <br /> �• 1'1 n htie 1YPnd Mama . y""• Min �aY YnRY . <br /> ;r aY(I,ntll 90 Not Write Below This line <br />