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`. 1 e�je '1Cjr rYD/Mirlled. <br /> ,,NIFORM "AZARpOUS -: 1 ,fltiratod�us€�A l�1+M <br /> ' WASTE MANIFEST <br /> 3 cienarator Mateo and Addy 0 PL <br /> Ql�,,, <br /> GA . ql `�5_ y^(3=3! ryj <br /> 6- T■naporttx•t pany Nam. �0 8. US EPA ID Number $tate T a>to <br /> i A IP <br /> CF- 10 0. Traeeportttla- <br /> ` CY^ 7. Transporter 2 Company Name a. US EPA ID Number E.G"teT _ <br /> F:.TianapoReda I'batte :y::,_ - <br /> 8. 6papNameSiddresa 10. US EPA ID Number GL am*SFacig &V <br /> n 1 �Fj111Y /r c <br /> i J LFd, fi1itCid <br /> NA 5A S I �/ rL F#d' :Phone ! <br /> 4 _ g4rb -7. I , t5 a o6�. <br /> Z 12. Containers 13. Tota! 11: :-. <br /> Qu <br /> D <br /> yy 11. US DOT Description Proper Shipping Name,Ne:srd Cleaa,and ID Number} No. Type ardity <br /> /V <br /> O.1 L TA N�, 10 <br /> Z Z <br /> r� EP <br /> E A 4 3r1 � w110 ile 11 <br /> it N Strata --: <br /> E b. <br /> o R I I EPA/Other <br /> � n <br /> m ;.ry.:. ....r.. <br /> i o R c EPA/OMtar- - <br /> State -.6 <br /> LU <br /> d. <br /> toK ttendMg Codes far WaataaLMed Aborr <br /> jZ J. Additional Descriptions lot Matertais Listed Above s! b <br /> M Pmt V rk n eta ism <br /> ... a. � ; , <br /> _W itrsSAaO I It7. JAt i36?vIL <br /> — <br /> 15. Special Handling inatruotiona and Additional information <br /> 4 <br /> Z <br /> W <br /> GENERATOR'S CERTIFICATION. I hereby declare that the contents of this consignment are fully and accurately described above by proper ahippinll <br /> ;! name and are classified. packed, marked, and labeled, and are in all respect$in proper condition for transport by highway according to appllcab! <br /> dinternational and national government regulations. <br /> If I am a large quantity generator.I certify that 1 have a program in piece to reduce the volume and toxicity of waste generated to the degree I have) <br /> it determined to be economically practicable and :hat I have sciected the practicable method of treatment, storage, or disposal currently available t <br /> O me which minimizes the present and future threat to human health and.the environment: OR, if I am a small quantity generator. I have made'a goof <br /> r faith effort to minimize my waste generation and select the best waste anagemenhod that is available to me and that I can afford. <br /> I <br /> Z Printed/Typed Name Signature _.o4-- e ay y <br /> u, <br /> IV <br /> Uj 17. Transporter 1 Acknowledgement of Receipt ol,Matenals 'I <br /> W <br /> Z A Printed/Typed Nama Signa <br /> Month Aay ? <br /> t: S <br /> P 1a. Transporter Acknowledgement 2 Ackledment of Receipt of Materials <br /> O Month Day 4 <br /> L <br /> T Printed/Typed Name nature I U E <br /> i Z I <br /> 19. Discrepancy Indication Space' <br /> F <br /> A <br /> I C <br /> 1 I <br /> L <br /> 1 20. facility Owner or Operator ication of re tipt of hexa ouz materials covered by this mamllest except a ttem <br /> T Prime <br /> Signature "Mtn Oay t <br /> Y <br /> I <br /> # <br /> DHS 8022 A(tra7} 1h� TSOF SENDS 5 COPY TO DOHS WITHIN 30 INS TIONSO T#1E BACK <br /> (Rt v.988 Previous editions are obsolete. To'P.0 x 3�, Saaamertfo, CA 95812 <br /> I <br />