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V1. <br />Jul 1'jul.W LOWRY, INC <br />Wickr" r' <br />Please prlMmtype. (Form OeSiped for use on Niter (12 -pitch) typewitar.) <br />iris <br />5-698-348 <br />A <br />Form Appfaied, OMB W 205D-0 <br />ERA F�rn6700-292 (Rev, 3�-%) Preyious edliond are obsolete. 01F9IGpfATVD FACILITY TO GENERA <br />UNIFORM HAZARDOUS <br />1. Generator Maitre' <br />L Page 1 of 3. Emergency Reipm <br />nifer.I.Tracking Number <br />WASTE MANIFEST <br />JJK <br />-t4934 <br />S. Gowatar's Nama and Mailing Addra&s Goninfors SleArldress ji differw wn mailing address) <br />Cemab's Phone: <br />6. Trarmpoder 1 Company Name U.S. EPA ID Dumber <br />7, Transporter 2 Coupiny ftie U.S. EPA ID Number <br />CAT lac r%,j <br />S. Designated Rdlity, Name and 5fleAddiem U.S. EPA TD Nun ber <br />A- <br />10 If H103A 13 <br />Sa. <br />9b. U.S. DOT Dew*;n (hoe" Proper Shipping ftne, ha=G" Miumber, <br />10, Con <br />11, T.W1 <br />12. and <br />13. Moe Codes <br />Type <br />HM <br />Quark <br />vyMol. <br />ca <br />'XiN R --Pa P' <br />2. <br />LN <br />IR <br />3, <br />OF-RTIFIC-ATS <br />c)FRECYOUNG <br />EF.. W 17' <br />LjVra��!Ves <br />5, OUVRATWSKIFFMOICS CERTIFICATION; I "Py dedwe That the consents of ft oorrsIgnmentars tatty and a=ralefy de3obed above by ft Prop& WPPiV name, and we WsArd, pailaged, <br />Motto and labefedoacarded, and are In all mspects in prmr mulifion faf transport 2ccouOrS to app1i;aMe Intemadomal and raftaw govern ooAl rM19119ne. fl export shoment wW I am the Primary <br />ExK&r. I w* MI ft eentents of this oftnsi nirrtwd copWm to the Iowa of the aKadval EPAAdnniedgment of Consent. <br />I cw* that Ow waste mindir0lon smlM Ideriffed in 40 CFR Z6227(a) Or 1 am a lenge Qmty Wwgar) ok%, rd I Ern 0 ansa quenlity 9mmiol) is crus, <br />GammWWWofs PM OTypod Name Month Day V <br />L'a <br />j % hernallonal Sh rents <br />01"10U.S. E]Evw tom, U.S. Poetofentrwext <br />Tmqvder signaka ffm mods Q*): Data teasing U.S- <br />7"afto Name <br />z <br />Tcj;-- Month Day 1 <br />S"Iuv <br />ZIAln A S L2 ---- IULX2211 e., <br />18&. Disoreparvy Irtdhtdort Space 1-1 owntity, 7 Rtsfto E]PaM RejKvWn ❑ RA R*0101 <br />Lkinl%d Reference Nwrber <br />1ft-Aternate Fatty (or GBreretorl U.S. EPA 10 Number: <br />iJ <br />FacillYs Phone; <br />vi <br />180o SighWo- cifAwma Fadgj -(or Wetalor) i <br />Mom) Day <br />19. PwaWalig Waste Dort Management Moto Codes (1.0, codes br hazardous waats heoirrem, dspsal, and r9quilng "ms) <br />ZQ. Designmd F8:1111v Own of or Orator. Ce 0 cadw of i ecelp i of hazardm rnaledM 0%wod by N mandlest except as now in 1161n, A aa <br />Pr4rdfryped Name wnu, Day <br />ERA F�rn6700-292 (Rev, 3�-%) Preyious edliond are obsolete. 01F9IGpfATVD FACILITY TO GENERA <br />