|
UG 27 '04 01:51PM HEINZ STOCKTON— P•2.
<br /> 1i i 'Friida•^En4ir' QiBf@rotectipnA 'Cr
<br /> d'om" 4,,'2qs =603 E fel! 3D• See Instructions on brick e e 6.
<br /> PP "p �. Depdrimevt of TWc Subitdneee�
<br /> 'F�1►,1R'e�q �t ;�9vkdon ikypawritar, 5 .. s Socrampnto "
<br /> n►..y:, crI{, fig r GPI,Fe�niP
<br /> 1., Gerteratvr's US EPA(D Nd,, Monifosf dQdumonF o. 2. page 1 {n,''rmation in the ahvd04'q'eeb9'
<br /> U K�I'Pk9i1�°t�YjrARD4,u S is nol'raquir?d by F,odoral low,
<br /> 11V�AOt'MAME RI d 4 I of }
<br /> 3. Generator':Nomc and ailir'q'Addross .
<br /> GenaCptor"s Phone t
<br /> Tfan!F orter 1 Company Name 6, U5 EPA Ib Number ; };
<br /> 0�0 y.,�. ' ►g ,W' huy�i ohan 013121212
<br /> T .ry e'�. �p �y '-
<br /> ,p Y '1-1 aq� wr`'�rlf •. .A `3 2. 2 tai 0
<br /> '7. Yipnsparlar 2 Cgmpany Nomc 8, US EPA ID Number
<br /> 1:
<br /> i'.D,ticlQfto Faailj Ndroa'and Sifa Address '10. US EPA ID Nurgbcitb
<br /> 7' wPi ,ie. . 1. .r •, N. X11, i , Virg IIt 'i i'
<br /> L t
<br /> A -4 '141"
<br /> a '1 10
<br /> Q ' ' 12. Containers 11, Total �,'4. Unh h
<br /> :l T','US p4T DesSrip}Ian including Propar5hippJng'Nafio(:Hazard Cross,and ID Nuniborl
<br /> V � No. Type Quanta Wt/voi
<br /> 4Z NF1 WORWtV 80LU11M.13,UN 424,rG IR �
<br /> LU
<br /> .in t4
<br /> ,a
<br /> � r q �i'l�xt.�..�. �M dr w r r • L,•: J Y t L��fn..'"'�'moo( F,y �',. .a '1
<br /> y,. �, iM S d � off Cf•J�{,,1r{y�+•. L� ��,'�' �M T''4,yn �1 t�,`' 7 ' I �r
<br /> � in• �' ',dy���+�a�' " "i'J`u�' � � r+���� I •,• "'Pt��f�j fid,.., 'a
<br /> � l ,d. .,� $rtf�3 '.���� �l,��F 5 ' _'r f•4�e ^Yyti.,�._.. � :v 20
<br /> Q ;n ,JtyXh„.e fiA:f� f• ,. .'�i "� �•a'r<�. y. i a;, . '.�- re + -
<br /> T r pB al N d1' I clldnd and k dllionpl I6fvrmdiion 16
<br /> pyyayh�e'�w,ag qsp h4 �${�F�� , �'�;
<br /> ..Y
<br /> Uj
<br /> '16,4EWERATQR'.5 CERLtf1t:A71bM: I hcmfiy deetbro that th'c contents of thio eoneignment ore Fully and oSauroy describedbovc`hy proper shipying ndmp and are d3ssificd,piked,
<br /> itte�ketly an<f obpled,and die in'alLrespeds in proper cohditfon for rmnsport by highway accgrding to opplicobb inkr,�ta'tional and national gonrnment'regulahvni,
<br /> If I�MI1 a large qutsnlily generator,I certify that I have a program In place to reduce the volume and toxicly of waste genergled.to'the degree I hale deloWned to be ecenom1ca11y
<br /> p tidiralilaand that)hwo selected Iha pree+arable'method of trratm..nt arorage,
<br /> or disposol mu entry availgb'le to me whish minimus shE'prosenY and future three)to Kaman healtA
<br /> O and Ihe`;nmir9niaenh,OR,if I vm a small quantify genetafor,I havc,madc a good faith effort to"minimize my waslo generation and salad fhc bit xvashi management mothod that i.
<br /> oS,itilaliWe Ip me and that Icon afford,
<br /> } Pr-/Typed ma y t �( Sigrsa�l� � r fj�vnth Dog Yep
<br /> Z "raj ,,fir 'x"',,�(• It
<br /> ,r ,„• ✓ 1 y 1 °Mi k1t
<br /> gi'Lu. ' 17,•Tions eriler 1'Acknowled emenl of Recel t of Materials +`
<br /> Uj `•p, Priiifed'A.ypcd Namo Signalu'aq I Mon D Yc
<br /> fJ.l .
<br /> U. .0'• 19', TrOn1 of er Ackri Isi amanf of Racai f of Materials
<br /> 0 Printed/Typed'Name Signature' FAonth Day Yac
<br /> L.W h
<br /> 14;.Diaerepaney ln�icatlon Spvice - '
<br /> A.
<br /> 20, Facili Owner or Operator Cerh lebtion of reeei f of hazardous materials ovaraci by this mail fest exca tax noted in ltd;19..'
<br /> j Printed/Tylped,Name Sianoluro q, ' Month Day ' .'�Yer-
<br /> DO NOT'Wk-ITV.BE'LCt11Vi1HIS LINE.
<br /> DTSC'8Q$2A i1/vq) Yellow: GENERATOR RETAIN
<br /> EPA e7Q0—?2
<br />
|