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goo. 111 <br /> WettA"AYerNOV fi ''�07dC t311bs4aneM("rOtllfgl <br /> - � .>f+�"�'��xPi"r,��'•_ e <br /> IL-1h ag <br /> ���aa�� //������jj HAZARD S : »ratora U$EPA to ria.' <br /> aJNIF�/llale� + '` <br /> WASTE MANIFEST //' Ntttlflpa� <br /> S, panaratces Nana and Mailing Addrs <br /> inpbjL <br /> �d w ��m�D� S�ti 70 0 >♦ � 11�- c nyes P, - - <br /> 4. G*nester'§Phots(big) +4 <br /> Q 8. US EPA ID Number C.State]'ranaPOM@e p <br /> Ll <br /> 5. Trs er 1 Company No O —1 7,111 D. Ttanapaloes Phoria <br /> kn 7. Transporter 2 Company Name 8. US EPA ID Number E Statt7r{napoAera :1 <br /> F.Traaaporter's Phone <br /> 10. US EPA ID Number (>< State Far3lYys y: <br /> � CIR 9 Des�n}�IF bJ'T1 Nome <br /> mSantl 5i�;Address <br /> r ' ZZ� ca H Faclfdy'a Phais <br /> aQ �b fly © � 7l it <br /> Z 1 L t2. Containara t3. Total 14. 1. <br /> { cc Quantity Unit '1�raats No. <br /> O 11, US DOT Description(Including Proper Shipping Name,Hazard Claes,and ID Number) Ne I Type JW <br /> tlyo r <br /> �A. �/L'1i Stag <br /> U s, Ny w 1 5 EPA! <br /> Ot <br /> N �� L, c3I,D o 7 a o o <br /> State <br /> E <br /> b <br /> j Ot R - - I -EPA!}'� <br /> mi A 1 <br /> e T State <br /> 4 e A c• _ <br /> $ EPA/0ther <br /> State <br /> a W <br /> d. <br /> Z EPArt?tt»r <br /> —LLU <br /> W K. Hdlingi Code for Wastes Lfatad Above <br /> Z J. AddRlonal Afi <br /> Descriptions for ateriaiR Dated About aab. <br /> 3im <br /> uj <br /> d <br /> r 15. Special Handling Instructions'ate Additional Inforfnation . <br />� t <br /> Z <br /> I <br /> 4 IIL <br /> U GENERATOR'S CERTIFICATION: I hereby declare that.the contents of this consignment are fully and accurately described above by proper Shi cpii� <br /> Jname and are classified, packed, marked, and labeled, and are in all reapecta in proper condition for transport by highway according to app <br /> d inlemational and national government regulations. <br /> V7 if t am a large quantity generator,1 Certify that t have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br /> Cc determined to be economically practicable and that i have selected the practicable method of treatment, storage, or disposal currently available ti <br /> O me which minimizes the present and future threat to human health and the environment; OR, '1 am a Small quantity generator, I have made a gond <br /> >- faith effort to minimize my waste generation and select the beat waste management method Ina ' available to me and that I can afford. <br /> V <br /> Day Yi <br /> IJU P `Typed Nam!a� ). ignat re t /. Monfh <br />} t 'e � L' <br /> W <br /> ransporter 1 Acknowledgement of Receipt of Material$ <br /> R S t Month Cay Y <br /> ZA Printed/Typed Name y <br /> " S v <br /> LL 6 <br /> P 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> yy O Month Dog Y <br /> ) T PrintedfTyped Name 5ignaiure <br /> r V is <br /> Z <br /> 10. Discrepancy Indication Space <br /> F <br /> L A <br /> a C <br /> F t <br /> L <br /> I 20. FacilAy Owner or rDperator gagification eceipt of hazardous materiels covered by this manifest except s$n 'n hem 19. <br /> T Prints ante ~ OFF <br /> Signature Monfh CRY Y <br /> v 7171 <br /> of 1$8022 A 01 9b White: TSDF SE THIS COPY TO DOHS WITHIN 3 C7 NS ON THE BACK <br /> EPA 8700-22 <br /> (Rev.nes) Previous editions are obsolete. To: P. . Box 3000, Sacramento, CA 95812 . <br />