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y <br /> 4 <br /> f n <br /> ..�• '•I.r ¢r ie✓.:i�•r �.5 i � .{.''., �.,�jr(�{• r � •/.17.t'�. - .r,• '„�k /. d� <br /> Pled arrafit>AateroEwlt; <br /> __�.' � .oar i• <br /> 07 offiel <br /> 80 <br /> ' 4. Oanarsfors Ptsorle ••. g ®�ar 0�I.o! c t <br /> 6 opener t a.' U8 EPA 10 Number' <br /> ul <br /> ,. r• 6.. " <br /> N 7. Transpoidw 2 Company Nems' 8. US EPA ID Number <br /> m <br /> L• 9. Doalgnat dFacft Adder t0. US EPA ID Number <br /> Ono <br /> 12.cdal.kwa 13.Total <br /> 1 I. US DOT Osurlotma(klcluding Proper Shipping Name,Hazard Claw, n:b <br /> ,and ID Nuw) Ovarnily—, Ilts1] <br /> {IIt+• f No, TypeUFT 7(r <br /> IYd <br /> A <br /> ::I�Lri4S., <br /> I � WAIOSHer•'. ... _. <br /> .W.. w d. Slatm:r:r, <br /> f. <br /> LU EPA1Othar <br /> ' U <br /> N J.Addlilonal De for elerfala Listed K.)satMFirp Codas for, Liatedlbeye <br /> Z <br /> 9®� `� Ave, ivro- ' :p <br /> O <br /> 15. oral Handling In ucoona end Atl i• • I tion , O8 S�-7�� 4 <br /> �a an �§X i3 "T j Dr C D. r. r LJ 1(7 J NNuu <br /> r C , ofRr <br /> U.5' r p fE5 910VES HlvD RESPAiATD� -d(o® <br /> V 78. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contenls of this Consignment are fully and accurately described aboby proper ahyping name <br /> - <br /> and are classified,pockod,marked,and labeled,and are in all respects ie prve oper Contlillpn fpr transport highway according toapplicable irtatnational and <br /> Nnational Ronrnmenf regulations. - <br /> It I em a tarps quantity generator,I caritty that I heves a program N pia.a to reduce the volume end toxicity of waste gamraled to the degree I have determined <br /> O to be economically practicable and that I haw aalacied the practicable method of treatment,storage,or disposal currently available So nye Which minimizes ilia <br /> Y presanl and future threat to human health and the emnronmect;OR,If I am a small quantity generator,I have made a good faith etfan to mleA a my walla <br /> O generation and selact the bass waste management method that h—enable to me end that I Can alford. <br /> w <br /> Printed/yy a Nanta Signslur r etdn[h Day Year <br /> C7 <br /> W <br /> T 17.Transporter 1 Aeknowladgameat of Receipt of fetes date <br /> SIP itonlh Day Year <br /> Q A P ITyped Name ` y 'r <br /> w- o g i &t�.et 4'r �� '�1• i1`d ,e�rwc•g R ®6 0 3 1 <br /> P 1B.Trs p wisr 2 Acknowledgement of Receipt Of 1,18106418 <br /> to O <br /> U7 Prinladf Typed Name Signature month Dov Year <br /> E <br /> 7. Ft J <br /> M.Discrepancy indication Space '4 <br /> F <br /> A <br /> C <br /> " 1 <br /> I 20.Facility Owner or Operator Canillcalion of receipt of hazardous materiels covcred by this mantises except as noted in tlem s9. <br /> T <br /> y Printed/Typed Name Signature M�at� Day Year <br /> DHS 8022 A(I 188) Do Not Write Below This line <br /> i s EPA 8700-22 <br /> Previous editions are obsolute. Blue:GENERATOR SENDS THtS COPY TO DOHS W111-111430 DAY: <br /> i (ReY.�•B8) <br /> .+, To:P.O.Bc+t 400,Socromem;,CA 95812.0400 <br />