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PWm print or type.(Form desgned for use on elite(12-tall)lype'adleQ Fold Approved.OMB N.2050-0039 <br /> UNFORNHAZARDOU9 1.�wlONumkar 3.Pape td 3.Ememerq Ra PMm aNadwlTraNk Numbs <br /> WASTE MANIFEST Cpo2(( i 2G°- - 0108'75205 JJK <br /> s.OarcMgANamea 2w• aralors Silo Aridness lR aft.NanmI Mdress) <br /> GwNaVRSProm'. <br /> e.TmNromr, m u—FrAm Nunbm <br /> a.S v� P C 2 <br /> �(•n <br /> ,.TmNpMm 2pxnp,N. <br /> 8. sgnaed Fl/slily wma andsd Addlesa <br /> Fent sPhule I I" CA-1 J '7L O <br /> 9b.U5.Doi Dewipliwr(mdudN9PmpersNppiy Name,Puaq CWs,IDNUMa, 10.Conk It.Trial 12.UNI <br /> 9a. ,J.Wwk Coles <br /> HM ab Paddrq Gmup(dalyp No. Tyne Ouanaty NLVd. <br /> 1. UAL, G� 3,129 <br /> LOtCAs�Wcnrs p ye ,fG i..-A tAl(A- <br /> w . Zd• W-)2o� ✓ CO , u (fi r D b <br /> X ' 50►,meg �f DM y�f7 VLu <br /> 0.5 C�.wl14 <br /> it 4 cp -71135 F <br /> 11 SpaeN Nara Ingmdrmaarq/A'ddl9mWlnWnapw 0/(lJ �}v h:yWLn a) 1„-r�� <br /> l)Q,S�-�bri� +,ITJyti su,uiwi-��iSgS�ao2�-yl !i ►e7V - <br /> Ow <br /> {, ,vats. &,5P(CfIfT 0b6 ru9N (Dol0)DOU) 5 3 <br /> le. GENERATOR'9HKFERORTICERTIFICATION: patk9d, <br /> maNetl and IebekGp'aom�,and are dat,,am n prep,aMNon WVarapMeovrdrp W apprM In Wnalmdl nrannl 90mrn..rtdI90.,If ae NrrymanlaM I am Oa Finay <br /> bpxg.lI.W,Nal Na canlem501 Nis mnw.gnmad'U'W me nn arich Moaned EPAAdmwtedgmem Of Consrmt <br /> I ow*llal 0s waste,nim aarf=demand ge:Wbed N 40 CFR ra py(a)(II am atape amnay gam,M w Ib)(91 am a amaa Ruanay 9em,W)awe. <br /> G WODflvare PrinMrT2,sd�Wane 7 NqW NY Y. <br /> lam¢ y <br /> ,S.hM,aaonw SM1immw ❑Mlpnb V.S. ❑E aad fmrnUs %ddmayJ <br /> TmeFOnerswmlura(Weapa6 # Oda YaAy U.S.: <br /> Lo <br /> 17.Trsq IV MlmMedpmMaNebipt dMPsd9e <br /> �Tmreq IPd v SquWa MmT DaY Yea• <br /> 0 —7 zj <br /> Z Tran'p r zadn ryal Nam / 11 T M Kw <br /> ,9.dsvepwry <br /> 1Re deems vlMkalgn Spew ❑Gaamly ❑Type ❑Recd. ❑Pahl Re(adon ❑Fdlflgedwl <br /> NaMasl Rekew¢Nunber. <br /> MAMnak Fadayla Gee " U.S.EPAIDNunka <br /> U <br /> lei Faday'c Pnana: <br /> 1&.Swna!ue 0l Meme,Fadiy(m GemeaW( No=r DaY Year <br /> 2 <br /> N19.IWadam Wash RpanMwgenientMWudf.oMalSa.mdwWM1arxdm msle l,almem,diepmd,aglttyGYg syeluml <br /> 20.D.OVIdd FadII omler dr Gpereme C CIaMon d,wyd d lawdas dINOW6,rand bl ft ww�Mad'n lkm,8a <br /> 1 s D., mr <br /> w <br /> .� <br /> EPA Fm 970D 22(Re,M5)Pradom ed" are obsolete. OFSIGNATE D FACIL4fY TQAfESTiNATION STATE(IF FI EOUIREO) <br /> ga <br /> C'=s'kj 0 % 2017 <br /> &MRON , a TAL HEAMi <br /> PEf°"ITASEffJ!4„'ES <br />