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<br /> elite 112 it t4 -P 16107 n the shaded
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<br /> h �ff1eose_0hn1*r,type-. Form e No Manifest Document-N 2. �ge
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<br /> UNIFOR `HAZARDOUS of
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<br /> WAST U W
<br /> an tor's No a and,1
<br /> Aoiling Address �7
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<br /> Number
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<br /> Trahsporter 2 Cbm any NumL,
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<br /> S EPA ID Number 10.
<br /> 0 9.- D.,rgricii-CF-ciliti, and Site Add'ss I
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<br /> No. T e
<br /> Name,Hazard
<br /> a-inc Class,and ID Num er Uoniity Wt/Volqj,
<br /> I'l DOT Descriptio ludi�g Froper.S Shipping
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<br /> ilctmecnd are clasisifitid'i packed,
<br /> V ni are fully aM.accuratelyr described above by proper ship
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<br /> on Inme r government redulbtjon�.
<br /> 'GENERATOR'S CERTIFICATION: Iherebyd"laret at.th�c contents this�orsiq !�S�6,r'�ing.to.opplicable.inter.na.tionaI and.notion a g
<br /> rk6d,'and'lo ..condiiio�llbrlrqqspor!,byi highway
<br /> beled'.nd stein all res
<br /> espei�ts in to er..
<br /> generated determine to y
<br /> in P ace to 4&c.-the volume toxicity 0 waffle ger
<br /> to the d be economically
<br /> c h minimiies the present on'A fut6re threoi to humari-health
<br /> jj&I-1 certify that I ave a proo�am lily availo6le to me which A I am a large�uantl iK gener( d h ' i-cable mailri6d.of treatment,storage,or disposal'currently m Method th�t is
<br /> K p�acti�able and that I have seie�tsi t tie -c' "I have made 0 good faith effort.ro:ininimize my-waste generation and ieloct the.best
<br /> �R if I am,o In,31"(1-onfity generator; waste
<br /> 739age grit
<br /> and the ankironrilent;C
<br /> and that I can afford.
<br /> available to Me
<br /> 0 1 'r�" . .1 . . Signatur MonthDo),, -Year
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<br /> an�porter 1 Acknowled Month Day'!:':
<br /> 17, T, emeni of Receipt of Materials
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<br /> Signafuriii
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<br /> Printed/Typed No 3 12,
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<br /> 4 B. transporter 2 Acknowledgement of lkecei�$of Materials 7 Month Day. Year.
<br /> % Si g ture
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<br /> L A A4dnik I )r-Ooerijior Certification of receipi of hazardous material co e r his
<br /> s manifest exce as
<br /> __Lo� Focililyownert Signat on Day. Year
<br /> I F ure TOPRIATE PERMITS T AEC
<br /> T Printed/Typed tjlwe� 'A
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<br /> STE STR
<br /> W iANNEWIS
<br /> no NOT WRIT BELOW Ti 80
<br /> �e shaded areas
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<br /> by 7F !a
<br /> GENERATOR WITHIN 30,DAYS.
<br /> P TO
<br /> 'TSDF-ItENDS THIS,
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<br /> n�ii�h6zcrdovswost 4o �Ir
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<br /> iGenerators w a.sub
<br /> -copy and send to DTSC within 30 days.)
<br /> 'produ completed; Of this
<br /> DT5C 8022A(1/99)
<br /> A,1
<br /> -EP 70D 22:
<br />
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