|
05/2S/04 OS:05pm P. 002
<br /> :F "�'t'"e��'�-r.!1+°tt{ffise`�>rugm:r �{^af Y,.., cGr u',"''S°s wt2+`�;i t .. ,,:.._ ,�.. ,..,. !"F 1 ':,: ,1t� 4 r•i
<br /> •.st9■s'1 G4fj �eyt _ l" •",f:,`�°=,k
<br /> FonlrApgttowd`"a►16 x00039ru -24-00) SAe{wtshuchons on back of.pag� pMyarlmenfoFToxicSubtlepMoM: hoR
<br /> Dleade print
<br /> or lYpw FoiftsgeII2jlj tirxnb'.:s: .<
<br /> 1. �feMfatar!US EfrA ID Manifest Document No. 2. Poen 1 Infor�tlafien in the shaded esr a►
<br /> UNIFORM HAZARDO�JS :. ienofngltindbyFeJerallaw.
<br /> WASTE MANIFEST of
<br /> 3:GwN*W%Name and Mal%q Addms
<br /> C��t►rw� P� crc.4� Gv+,�R+t1 f t $fly uCp µ ",, ;
<br /> � `�10[1.{�' �x:700
<br /> '4:iietlbalors Phony`'{'
<br /> S.Transporter I Coieparty Naar d. US EPA ID Number tpoefir s iP y' ,�_
<br /> r.. �} 1 v partef!Pf70M: i9;':'tr•:y�,�.y,.:.r! , �. y,
<br /> 1Transporter 2 Company a 8. US EPA 10 Number
<br /> Co " _ _ - .,,p-afro'?` ,y'.'.ai'.:.r. ^D::,,! 5 a+-,i Y"?rEi`:'+F��` �,^5��- - k•..:
<br /> y ]l
<br /> V. Fad4Nara oral Site,Address 10. US EPA 10 Number, ?
<br /> C,. Teri* Sof do,
<br /> o,f ;�►V�'j'. +�.'+diry :R�Ap� �' ,w� „��+tea �����r���
<br /> 1 Contnitssra 15. Total 14 Unit
<br /> 11. US DOT Dowd pNan Unidudino Proper 5hippbp Name,Hazard Class,and ID Number}
<br /> No. T Quandly WI/Val # 'Wpijtit Inebeeh;:
<br /> Z ' M1�4yk'•: f�r•rhgrblr t,2Qv�d(.� IVIC��r �ilr,^ k'
<br /> 3 G C .1D��C e'ie/ d
<br /> E It
<br /> 0 N
<br /> E
<br /> N p
<br /> T a
<br /> T
<br /> F It
<br /> 09
<br /> U.1
<br /> gg t s ��� t trM1 y }itt r '* e5y
<br /> us
<br /> r11 a q� F �]. A '� t yy i 'F +1�'S , „r •c. .xr• '� i v
<br /> • '.� 5 YyFiY i6 �,E Z 4<S, 'r',' E K'it , i. :v_ ',���J,',,��. ••.•ty�}y
<br /> f "!`4• ((�� -•'V-Yt41^. T �3'}. k C ° L � jJ� `4� !• "�" ]e� .Y
<br /> 15 Speeld ftx%gineWxdaes and Additional Information
<br /> o , �_ Pfo�tle �t CF. Vn �#q d�S
<br /> Il P�'1'oP���Ife.. Clofhdt�i r�td ��P'�I��l. a�q}6�
<br /> � Hail' ��-r•�•K`r:. 4�'��k�>�--. chemT��
<br /> 19
<br /> ie0S W. &A-T�+tn Fbf'F
<br /> 1 b. ors CERTIFICATION: 16r–*6y declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,pnZW
<br /> marked,and labeled,and am in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br /> If I am a large quanti generator,I certify that I have o program in place to reduce the volume and toxicity of waste generated to tthe degree I have determined to be
<br /> :
<br /> :=and that I hwr ,selected the practicable method of treatment,storage,ordisposal currently avoiiaWe to me which minimizes the present and future threat to bummt health
<br /> anal alta enrlronment;OR,If I am a small quontiy generator,I have made a g faith effort to minimize my waste generation and select the best waste management method thd'u.
<br /> Cke
<br /> Q mrollable to me and that t we afford.
<br /> Prinwd/Typ d Notts ;• Sip t Month Day Year
<br /> Z o:.• .7
<br /> w T 17. Transporter 1 Acknowledgment of Receipt of Materials
<br /> W A Pd ted yped Nome SignaNn Month Day, Year
<br /> ■ %.' 04
<br /> U. 18. ran r 2 Ackn enf Receipt of Materials
<br /> O Rinled/Typed No.* .:• Signature Month Day .:...' `Yew
<br /> 1Qw E
<br /> U R
<br /> 19. Discrepancy Indication Space ,
<br /> Z
<br /> C
<br /> L
<br /> I 20. FacilityPOQ or Operator Certification of receipt of hazardous materials covered by this ma ' e t noted in Item 19,
<br /> T Prl Nome Signature Month Day
<br /> � Year
<br /> DO NOT WRITE BELOW THIS LINE. V .
<br /> DISC 8022A 11/99) Green: TRANSPORTER RETAINS
<br /> EPA 8700-22
<br />
|