Plnsae ndntatuoe. !Form deai0ned for use elite 2-oilrh)tvoewti[er,) FOi1D Approved, I No, 2050A0S9
<br />=PA FMm R7O!} P7 1, 8 M FM ed bone pre obi 10,
<br />UNIFpRMNA7AR000S 1.DmerelorjElls��-O,&TRWK
<br />2, Pagela
<br />9. ElnergeN.y R84Ponee Fnme
<br />a. wral"t Tfaaklm NYmaer
<br />WASTE MANIFEST CA07.
<br />000-7404449
<br />G g F
<br />5.Gefsralor3NamearAMa fVAdd�eb3 ria tDNRM �dm�Tlddemattmm ingaad�)
<br />3.PLA2N 1Q740'M 7THaes,
<br />{qa cn:952aZ241Trarwputer
<br />1 fmgaq Nemo U.S.f3AIDNumbef-%,AAG94�11>1Ttl9ttS:-1NG
<br />., :,,..�.., ..... .,.,..'N ,..CAMOOM64 IT,
<br />7. arwpabr2Canpaly riwne U.s.PAID NumW
<br />1. Der9WO FaOTfy Namead SuaApoleas x�
<br />.1 uu��. �.GR�aW.�A•'+LLGt „:W,, r ' a ' � > ., �: < u�z q iso�'"� „ y.1
<br />�N.
<br />.t...d'T �Yulti�T�uT�1FTIJSP.�i? •1 C. .� .y�A. .?'�J`,f ..�•r Y:. ., n. . T+—'�i_�ttvi.I, t
<br />GeGRDovA,�^i 45742�:-
<br />Fad! Picea°
<br />p&
<br />96• U.S.DOT D88*don (nduaQ Proper
<br />Name, H=rd awA ID Number,
<br />10. Gmwrh
<br />11. TOMS
<br />12. WR
<br />1s Codhs
<br />No,
<br />TYPe
<br />NM
<br />end Pukip GMw W"D
<br />t7.*
<br />MAU
<br />1:
<br />.,..v.r::_s,.,:.R.::•.�,,........��u
<br />MYO[nv.-,.;,
<br />w
<br />ir:�-.
<br />•223' 3
<br />AB8flR8ENe01t8'
<br />x :
<br />(p
<br />0-4+
<br />V
<br />,
<br />4
<br />ATROOkATUROT 'RE•C
<br />W,4
<br />SEEERG#iTl : ..
<br />. •
<br />16. GENUWGK'&OFFI]W6 CERTIFM.ATION:I
<br />derlhm tMlthecmyna hFNk mrigvnant as klyerd aaaemy deamlad above 6y Ne popersfdfgnp Pame,aM aie paIXaged,
<br />maMed aid WI;"p*AWod,®d are in al respe
<br />s in pmpermrA&n for hanspAl rdlm b applicable IrA=B§oaW and nafonal gbr lal mguW*M aeryMsMprwtv,e l am Ih Pdnary
<br />Eaporbr l mNy Net Ne amtents ofVz
<br />t=ksrmwmeta ornaauaace4(FAAdpMv"msntorCOWt
<br />I wty Natdp wash Mirktatlm MIM"
<br />In4OCFR26W(a)(dlamelagegw*eme6 quaNby geremlaj taws. '
<br />"
<br />e 4) , z o
<br />❑hnpMbU.B.
<br />❑Eepm hanlUS,. Patamdyleudc
<br />1 wkimm (for expose ortw
<br />Dam laaNng U.S':
<br />17. Tranapo twAdavwIo#r;w Q(RecoOt of Mdgiak
<br />M
<br />SC
<br />N
<br />�
<br />ren9podN2 yped
<br />&gnaLea tdW6
<br />K
<br />.
<br />rm*.o,
<br />16.Dismpancy
<br />160 FNtGeparWy lndlryan SPaoe ❑ Wendy
<br />❑Type ❑NesWaa ❑P'u F4.0m Ell
<br />Madkel Rskrmw Munber.
<br />166.Auar.ew FadSy(at oq
<br />U.S. EPA ID WMbef
<br />LL
<br />Fsdb's Phaa:
<br />w
<br />160 Sgnaae aApernBb etlly (aCvwraku)
<br />�.
<br />Month Day em.
<br />18.HuaNwa VJack mepwlMavrganoM hlotlrod Codes.a,
<br />mdeaMhszMdau; imsk toahren<dspoad.em regxying sy*mts)
<br />1
<br />I� I
<br />z
<br />3.
<br />a.
<br />20,
<br />DWOWM FOPOW(TMmrnr APnmfnr faAfraYon C(
<br />Q(hmvdoucM Warmed by (ho rumba[ ox9opt w n4o in Wn 16a ... -
<br />a M -t y aar
<br />=PA FMm R7O!} P7 1, 8 M FM ed bone pre obi 10,
<br />
|