Laserfiche WebLink
stnt.of Notection Agency See Instructions on back v C "ge 6. 04 fork5.1asiornnce,. Contra <br /> 4p"ovd ame No,2050-0039(Expires 9-30-96) 4� k C.1ifoi <br /> pease price or". Form designed fen."on eke(1120" <br /> Generator's US EPA ID No. ManilesT Documen 0. 2. Page I information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low. <br /> WASTE MANIFEST of <br /> N <br /> 3, Generator's Mail' Add <br /> ameTd 1�,�Z7-4c, <br /> 4A <br /> 1/-'j'y4X�,( K S TEL 110-1-11� <br /> C14 <br /> tel 4. Generator's Mone j <br /> 6. US EPA ID Number C.;S4*4 tMkPo"!s ID`, <br /> S. Transporter I Company Name <br /> P-- <br /> coc "VC 1.3 lei IZ_ ph!.. <br /> 7. Transporter 2 Company Name G. US EPA ID Number E.'-staft 7"Osporw-2 ILP <br /> U <br /> F,7-T--P- <br /> \JG., $ft <br /> 9, Designated Facility Norne and She Address 10. US EPA ID Number <br /> -vi . --j t'.- <br /> \j <br /> 1) U .112.4Cantainers 13, T040I I <br /> 11. U!5 <br /> -�.4;1441Proper thlppinQ Name,Hazard Cl.'..."and ID N um,ber')' fi Wt/Voi 1:`W =I , <br /> 01, <br /> a. 51 <br /> G P <br /> CoC-4 'J'.--- 101 -�LE--'- <br /> 0 1., 'i <br /> N b <br /> E E?,QR% <br /> C4 <br /> C. <br /> 0 <br /> R <br /> Uj 'jgm ei- <br /> Uj <br /> U !EPA/01h;411r-1-1' <br /> "Q1 <br /> CL <br /> LLJ <br /> A <br /> Z <br /> 0 is, Special Handling Instructions and Additional Information R I <br /> i81 i <br /> 1A <br /> 97 <br /> P i <br /> tu <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents Of this consignment are fully and accurately described above by proper shipping name and ore classified, <br /> proper condition for transport by highway according to applicable international and national government regulations. <br /> pocked,marked,and laWled,and are in all respects in <br /> if q am *large quantity geocrotor. I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> to generation and select the lbess <br /> threat to human health acrd the environment;OR,if I am a small quantity generator, I have made a good faith effort to minimize my waste <br /> waste monagemendt method shed is available to me and that I can afford. Month Day Year <br /> ��Yec <br /> L 1� <br /> Typed Na ' Sig re- <br /> '4 <br /> 0 Prime Typed i <br /> y Na"115 <br /> )C 14 19 C V— <br /> r.ns <br /> .4 -;n <br /> Z T 17. rocs -r I Ac"wfUlgement of Receipt of Materials —FM th Y-1 <br /> A Printed/Typed me n Uj Signatur <br /> 'D <br /> Uj S <br /> Transporter 2 Acknowledgement of Receipt of Materials Month Day Year <br /> Lk- pay <br /> Name Signature <br /> 0 <br /> 19. Discrepancy Indication Space <br /> A <br /> C <br /> 20. Facility Owner or Operotor Certification of rectiet of hazardous materials covered by this manifest"ce2'as noted in hern 19. Month Day Year <br /> S-ia <br /> I Printed/Typed Name nature <br /> Y <br /> T" Ic <br /> DO NOT WRITE BELOW THIS LINE. <br /> DT5C 8022A (1/951 <br /> pp. A7na—?2 <br />