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State of Call; Protection Agency <br /> foitni6I—Environmentol ..)"..Seg intfiuitions'onbc[CKOTpQqu%or <br /> 0039[Expires 9-30.9IFY.". <br /> Page <br /> F6fiW46siI for.use on erife.1 12-'itc <br /> Form App OMB rmat! ft,in t i, <br /> J��PA 11)No R, <br /> not reIciuked'4.Fe <br /> �Fe 11 <br /> l.rhiorrs US % <br /> IDS .2, <br /> toe, <br /> M AA! RDO <br /> Iffl,M i VA�7 7.4, <br /> WASTE <br /> UNIFORM <br /> IIANIFEst-I. <br /> & <br /> 'and Mailing AJI <br /> 3. Generator's No <br /> 4 <br /> '4 N 47.1 <br /> %�A <br /> K <br /> 4, <br /> L <br /> 4. Generator to <br /> " <br /> umber <br /> 5. <br /> C14 5. Transporter I Company Nome <br /> T, <br /> -6 Filter rec-:r UM Qr' <br /> JY b <br /> 0 US EPA 10 N `0 WAU,l <br /> 00� 7.;Transporter 2 CompI Name- -4 <br /> �TsF-oder <br /> . <br /> O <br /> tn <br /> L .'­io US EPA ID Nu�nDesignated0 Name and Site Address <br /> 142167 E7AM <br /> M- <br /> ota <br /> tw%V 93MB 4,-Unit, <br /> II Us DOT Description cIHazard- <br /> Cl6n ID Num pe rY <br /> 'Z 2 <br /> EPA/iZlher 1- <br /> i } <br /> ow— <br /> Wade <br /> C o <br /> � C <br /> t­ �Z_ <br /> 0 <br /> C <br /> .R, rategwM <br /> -K <br /> 0 <br /> C—AD <br /> -EPN;Othfir <br /> 0 <br /> L <br /> 7-- <br /> LLAd. <br /> .............. 1/0-thII <br /> :;YI1 �IEPA <br /> L <br /> z <br /> LU <br /> Z. <br /> jj'WI 1AQ <br /> W -,.irIcmC __M`V <br /> Z <br /> 7 1 He,` <br /> R <br /> 4- <br /> '65 <br /> IN <br /> _Uj <br /> V, ra <br /> CV, <br /> Z <br /> :0 15 Special Handling Instructions and Addetwnal`Informa_honmr r." r % <br /> S <br /> ly, <br /> Ot <br /> 0 -46 <br /> 400"Pl. A ? . j I <br /> ILI <br /> CII IIIC,�; )49 29- <br /> ..... -551 <br /> ._7 CA <br /> d"packed' <br /> 'me and are-�Iassitie .I <br /> raI descriloe8.above by proper s ipring.np <br /> are fully and accu <br /> 116 CtRTIFICATION:,Nereloy declare that the conr-rits a t IS const nmenh <br /> high by according to.oPplica6le'Wern6t-ional an8naliona governmen!reI j In <br /> a <br /> propel condition fo� <br /> jesoects,Iin pr <br /> ked,and labeled,an transpI I <br /> :...nnar dlo�e in <br /> have determinI <br /> econ"'c' <br /> place too-redo4e t <br /> L,('certify-that he volume and toI of waste generated III the degree, <br /> 'iIt 6V6 a Pro, 'imiies'kke preserit ond'huiure threat to human'64.1 <br /> if I am a to""'quanfi. generator,dycimi." ..i�8ispos6l'c6rrently�avoila6�e to,nne,�vhick min _woite'.mandge.me �th J h <br /> Y waste gen r <br /> licable and as <br /> '60111 therracticable'method o,trectiment,storage, CI and'select the-,111 -0 ;t.01 <br /> proc that 1: ova ad failheffoh to mi.imi 0.m <br /> I quantity generator,.)hove made 090. <br /> and the environment;OR,If I am a sm <br /> ,I L s .�; , . -.. . Month. D Yeae', <br /> a-1 cavi'afford.available to me and that <br /> % Iur 7 <br /> PrintI NarI <br /> �Z <br /> Y <br /> III af-ReI of Materials Si t Month Dof - hL <br /> T '17 .'Train rier 1,`Xckn6wlecl em <br /> In, 72: <br /> R <br /> A Printed T 'No 6 A <br /> Uj <br /> Month-o •I Trans orter I. cnowledoemt m2tgri Me <br /> LL. Akent oIn. <br /> _:.r. 0 'frinled/Typecl.Nome Signature <br /> rn <br /> I <br /> T <br /> .17 <br /> L: <br /> < <br /> _'19. Discrepa a <br /> Incyl!nclic6tioniiSpIcIce, <br /> Fr- <br /> i f <br /> A <br /> _C <br /> Z, <br /> .�' <br /> 20. 'Facility Owner r OEeIrator�Zorfificdtiori'of.race pt of hazardous rriotenols covered this-manifest xce I cis noted irI 19; A <br /> Mo <br /> TPrinied/Typed,Nwirm - <br /> 3j <br /> Sign <br /> j'r:­: <br /> -k. <br /> :Y <br /> Y. <br /> E" <br /> LIN <br /> OWTHIS <br /> DO .NOT im BEL <br /> ; <br /> 8022A 0 Yell w- GENERATOR-RETAINS <br /> EPA <br />