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s State of drew Je' rsey
<br />Cie artment'of Environmental Protection and Energy .
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<br />Hazardous Waste Regulation Program ;
<br />Manifest Section
<br />CN 421, Trenton, NJ 08625-0421
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<br />UNIFORM HAZARDOUS
<br />1• Generator's U5 EPA i� t c Mani'est 2. Pace i I �r :n sF-,'-c-' areas
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<br />WASTE MANIFEST I_ i. h I I I = <, fi , C,j fli._ I .. :
<br />3. Generato s NameYand ftMailing Address A. Staie tla,•u est Ono c nt.INu e
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<br />5: nsa r 1 GYM-ry Name - SEP +iL71 G.. state Ira. -,&1 J ,
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<br />7. Transposer 2 Company game 6. US EPA ILD Number D. Trarsporter's
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<br />Facility Name and Site Address 10. US EPA I0.Number Q t No
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<br />"S � 7 ° )escnption (!mludiag Proper Sh:Ac;ng ,"+ amc. kaza. d Class or Diwwori, I.
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<br />h 0Number and Packing, Group)... - `' I', „ Waste No.
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<br />JAdedicnai Desi,jptxcns for Matenals L-sted fav, K Yandtin9 Cooe9 for Vdastes Listed Abc re
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<br />1 S. Special Handling Instructions and Additional "Information - I
<br />7f� '�YCR EIS #.a. SANTA EE RAILWOY, EPP YFj taiW10Sae-1-43, T� art 4+1 i
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<br />I !':4 044L.Y, BUT T 'RY EPA AND/ CR, INS; UHF BEHEF__12;ALLY s1e V�:L ,-
<br />1'r GEN FiATOR't CERTIFICATION: I hereby.decae t`-,a::he contents of this consignment are fully and accurately eescribw above hy-proper shipping. name and a e Y
<br />I _sried pa ked, marked, and labeled and are in all resuects in proper condition for transport by highway according to applicable ime national aW national goverrl^7ent
<br />if 1 om a large quantity generator, I cer;i•y shat 1 have a program in place tc reduce the vok me`and toxicity of as:e gen ed to the degree I have deem red
<br />to be economically practicable and that I have selected the practicable method of treatmert. storage, or dlspcsa, cu ran y ava lute is me wrl r. m nlm.zes the sent
<br />and tvture threat to human health and the environment; OR. if I n -r a small quantity generator, 1 have rnada a goo„ faitn ei,ort :a minIM. -e rrtY waste gene tion
<br />Nn eelect the best waste rra-:acement method that is available tome and that loan afford.
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<br />XV
<br />T 17, Tra'.acr:er 1 Acknowledaernent of Receipt of Materials
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<br />cA Kno'.vledgement of Receipt of Materials
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<br />3—TSD MAIL TO -GENERATOR eco
<br />SIGNATURE AND INFORMATION MUST BE LEGIBLE UN ALL e. F tb
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