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v,o,«ton A'. <br /> Fenn AM. OMB No.ID70-W391Ex ares 9,10 Aj SN instructions on back at page 6. o.aa„m.m ah T.—s6..c <br /> Ilene prntahype, term drsiaus'd for use>A(IIPdd,l7W"'^M"b - Sac.miwuo.C.14--- <br /> . --- <br /> 14 <br /> lihama <br /> 1. Genwa /,US EPA ID ,t <br /> Momiesf DocurrwNo. 2. Pape 1 Information in Me shaded areas <br /> UNIFORM HAZARDOUS q o not rewired by Fecimal 1. <br /> WASTE MANIFEST C C S2 �� �� 3 / / of <br /> 3. Ga;wrsrror',No.ad Mailing Addrwc �G�C C -r .' 11 4 R 6 3 791 <br /> sn A. Generaro:,Phan. (�'�( ,Q ? f: - c c� ) s a <br /> Trampormn 1 Company Nome l a. US EPA ID Number, <br /> m <br /> f ECOLOGY CONTROL INDUSTRIES C AlD r ' r > 7 <br /> -e 7. T 2 Nerve 8. US EPA ID Number <br /> < nsWsoaer Company <br /> M Z 9. Deye,;abd�,emol4;It,9.Naar ad Sic Address 10. US EPA ID Number <br /> i kgr,"d i.,Ctl <br /> j 0 255 Parr Blvd. 1C ,Phone u <br /> t F.il lm_nd. ,. ?4c01 r' 0 f) 4 ti 6 3 r ,. %.• t sh 23S-1593 ' <br /> U 12. Career. 13. Taal 14 Unit � .. <br /> Z 11. US DOT Description(includep Proper Shipping Name,Hazard Class,and ID Number) No. T Wamty Wt/Vel I I.,.Wom Number <br /> C0-tVA4-RCRA Hazanicau Waste Solid C M $6 . <br /> ci E Wa to Empty Storage Talk FT <br /> INb 01011 Y-A 16 P <br /> h m N Is.OP <br /> A <br /> 1 a T a• Y' <br /> °? R , r <br /> R I <br /> ! ZZ d. <br /> (t ' <br /> u <br /> f Q <br /> 09 <br /> l N <br /> W <br /> Z <br /> • O 15. Special Handling Instructions and Addfxenml Infarmmien <br /> Keep at av from sauces of ilnitiSx� P�].ways wear hsr<�ata Nhen rktnq aroAAn, <br /> Z U.G.S.T. 's 24 Hr. Contact N- Elef .; . //1 -_S <br /> / W <br /> - F <br /> 16. GENIRATOR'S CIRTIFWATICM I hereby declare that the conlena of this consignmerrl an fully o d accurately described above by proper,hipping name and an classified, <br /> packed,marked,and labeled,ad an in oil respects,in proper condition for transport by highway according to applicable international and national gowmmant regulations. <br /> U <br /> J If 1 am a large a 1 cert that I haw a pregnant 'n lace to reduce the wlume and toi of waste enerated to to degree I hove determk,ed to be <br /> 9 quantity Sed that <br /> I comfy p w p ;tib/ q <br /> —y <br /> economically practicable and tM I haw selected the practicable method of tooem,,brags, or disposal currently available to me which minimizes the present and future <br /> W threat to human health and the emiro;mmn; OR, 8 1 am a small warmly 9e,en mr, I how made a good faith effort to minimize my wash germration and seise the best <br /> j a waste mronagernent method tw is dable to ma and that I can afford. <br /> O P e ed/Typed Nene- - SignaMn j Month, Day Year. <br /> Z T 17. T 1 A<knowled of Recle of Materiah <br /> s w •/ Morph Day, 'lA !Fieiedi�Typsi '.es <br /> eer <br /> W g 18. Tromparew 2 Acknowledgennerse,of Receipt of Materich <br /> Prkhledme/Typed NaSignature Math Day Year <br /> U E <br /> e R <br /> Y N 19. Discrepancy indication Spam <br /> U A <br /> 1 Z C <br /> ' � 1 <br /> 1 t <br /> ! 1 20. foci Owmn or Cer6ficaten of nevi of hazardous m beefs coavered tris manliest ezc t as .red in Item 19. <br /> + T hbed/Typed Nave Slpnure More, Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DISC 8D72A (1/95) Yellow: GENERATOR RETAINS <br /> EPA p00--22 <br />