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Jul 11 03 10.36a p•5 <br />Scat■ of CmleFanio--EmirmnmanM9 FhoWtion Agency <br />fmfi AppTRlltl OMbT1o.1Q30- 034 (EnQis®s 9 '-490 See instructions an flack of page 0. Depgorbwo of Toss Saboancn Conaoi <br />pt�o� �� , �� dc�i � � o� �I�II t iir�ii��1 i i So�re�aMa. CGliFotnio <br />2 <br />HAZARvouS us ens a �. ae fess 0aawnenr N■ 2. Peg■ i tn � x"-600 <br />WASTE MANIFEST area - <br />UNIFORM <br />j <br />I '? 1, EM <br />3. 4an'antar'aW and W.Lk.g Ad are A. Slots 21-751171 <br />qt <br />W <br />T <br />W <br />4. Genarow's Phone - <br />6. US CPA 10 Number <br />C. Stats Iron�awe, !D { .I <br />S. Transporter 1 Compemy Name r <br />P,wod/Typed Ne.e <br />® <br />EV KREEN E(+litRONMENTAL SERVICESD, <br />LC IAfD19'8121411134216 <br />Transporrar-s Picone (gam 97Z-5284 <br />21 <br />Q <br />U <br />. Tra®enagorl■r nnppaaryName 8. US EPA 10 hprm <br />7 7 C,,, <br />E Stale Trantpar""ra 10IR■a■rv■a.! <br />I <br />r <br />�f�s.4Al <br />8 { W7 +� Y'• 3 (I ^ G <br />! F. Tranapor4ara P1com. <br />d <br />eu <br />�a <br />9. Dasignorod Facility NOme and $Ise Add US 10 Nure <br />,�� <br />G. SsmsPescifiy'+10 <br />6 Aio10 al9'E4(9,4113; 1101 <br />-1 eg <br />1021 Begesa Road <br />151414 <br />!i- FocVFW. Shona <br />0 1.4 51- <br />�0 <br />AiD 9 4 <br />3 1 <br />.r.4 <br />t I U'S DOT UeunpNon iincludirrg Prapor 5hipphrg Norex, Hosard Clan, arn:l m PWmbar) <br />12. canto wl 13. Tatai 14. Unit <br />�, f ovolwity Wt/val ,. v mets skqwjw <br />1J <br />. <br />Stmt■ <br />Slab <br />b. 19AeACIA <br />v I R <br />a A <br />a. <br />S+aa" <br />q T <br />W <br />,. .. t EPA/Other <br />R <br />- <br />same <br />re <br />d_ <br />ij EPAJCthor <br />V <br />w_ <br />v2P <br />J. Add'elianal 0■ 111-1ieas far Nwranol. I,., -Above <br />K, Wondli" < a for waat� field Aber+. <br />b <br />JS o It , <br />{�a <br />Q <br />z <br />d <br />a <br />Is. Cinj Handling Inatruetions and ACditional Inienmotlsn <br />24 Bout 66iergy Respoflse 7e1. Na. CNEMTREC 1-900-424-9300 <br />z I <br />DOT ERG +; t � Wear protective clothing <br />Bat at La�>� <br />120 <br />Sales Order <br />-' <br />r shi norma and ar■ slatsitied, pocked, <br />I 16. (FINGRAT®R'S CEITIFPtAT10Nc 1 fW46Y decl0r" 'hot the contents of Ihn cansignmane ors tert'ry and accurahit. dexribad lova by PrsW PPi^D <br />far honaporr ty highvraY aCCOrding ^o appucoola insrnotional and naliawi gaearnenanr rogtrlmlions. <br />Q <br />U <br />marked. and bbebd, end are,n all 1-0"n in prop"' condition <br />!F t am o larg■ a•onsly 4e^•rater, I earrily enar haw o «o®aam in pima■ 1n reduu ih■ ,nla■s" and so■feily of w 4 Corwated 10 the degrw ! have detorn+in■d to be mco mmicolly <br />�obl whi0ah inivnizes �t m <br />ma ad" 6 <br />®omd <br />prodieable and that I av" {elected tie P si niero,aafl} �� oda c ter th aEPort torcrnntinua" <br />mod the errrirenmeV; OR, l am o 1.00 y g 8 <br />®seems <br />y gens oitd saloee bass woos rnm na <br />0vodab4—. m" and that 1 con affcrd. <br />Mar Year <br />Y <br />S <br />P ' y ad Nom" <br />V <br />w <br />1 17 runt ler k a mans of R"cat f of Met"*Iola <br />. ' I $ign0iure <br />FAoe}h Day Year <br />r <br />W <br />R Niamod/TYr ® <br />- - � <br />qt <br />W <br />T <br />W <br />P <br />rear 2 Ackne+vse amens e <br />T <br />P,wod/Typed Ne.e <br />R <br />Q <br />U <br />c� aee <br />19. Discrepancy MdiC Vryspace <br />F <br />A <br />C <br />1 <br />1i0. Fasi147 Cwnar ar pperaror Crei�. <br />j <br />Y <br />PrintediTYped Nome <br />� <br />Do NOT WRITE BELOW THIS LINE. {� <br />CTSC 8022A 0/9e1 <br />EPA V00-42 <br />0 <br />Year�9 <br />ew d� <br />