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-P yAe er). ToxicSubstance.Con-. <br /> 7 HAZARDOUG I. Ganeralar's US EPA ID No. Sacramem; <br /> _ t MANIFEST Main 2. Pepe f <br /> L [ ., Docum is not required <br /> a the shaded er. <br /> J. Generator'ZName and Mailing�Aldtlrsu Q U °! � is not required by Federal ler <br /> V J')Jr I--R %t� r\f:'r- 0i- CC�jaf� A. Stale Mani/et q��aa <br /> 9q•5C ; >:.:J� , 8"72 l d 5 <br /> e. .e oto s Phone Sofa Qeneretor's ID <br /> S. Transporter I Company Name <br /> w e. US EPA ID Number <br /> a /�) /�;5 p yV /f LC/ f C. Stale Transpoder's 10 <br /> < /�` ! " ` �� 1 .3 • ;� D. Trenaporter'a Phona <br /> N <br /> m 7. Transporter 2 Company Nama `v - _ <br /> g fl US EPA ID Number _ <br /> m E. Stale Tran port q <br /> 9. Designated Facility Name and Site Address F. Tranaporter's Phone <br /> �)L �..5`r !, IO' US EPA 10 Number <br /> / �it, L. G. State Facility's ID <br /> /I:q C/i 9')1.Y.:. H. Facigty's Phnee <br /> a f I. US DOT Indudi ti <br /> Descrp' on(including <br /> _ J ( ^9 p,°Par Shipping Name,Haxud Class,and ID Number) I2 Containers IS. Total Ia, <br /> U a. Quantity Unit West*N- <br /> Z t'G./T_5 .Si cRa C. c- No. Type WI/Vol <br /> G <br /> E G/14/F Q/ l.;R it <br /> state <br /> oN It. / 47 / t '� C) L. i, �a EPA Omer <br /> m A /y' ` <br /> m T State <br /> d O <br /> a R c EPA Other <br /> S <br /> m <br /> State <br /> 1w, tl. EPA,Other <br /> Z <br /> w <br /> U <br /> Slate <br /> w <br /> N J. Additional EPA Other <br /> 2 fMacripliona la Materials Listed Above <br /> qti'�S i c tin .` Rip ro,vL Ti►N'f� 1 `p K. Handling Codes ler Wastes Luted A Ove <br /> ¢ ?Lrr. x(35 ��A�IC� a- o, b. <br /> J <br /> Q <br /> Z C. d. <br /> O <br /> Q I5. Spacial Handling Instructions and Additional Information <br /> Z L^ 4 ,% C 6 <br /> f <br /> J <br /> J <br /> O 18. <br /> J andGENERATOR'S CERTIFICATION: I hereby decline that the contents of this consignment ere full y <br /> 4 eM are clessiltrW,packed,marked,and labeled,arW era in ell respects in proper consignment n ant for fully <br /> and by highway national Y and accurate) y accords above by proper ahipp�^:nare <br /> N povernmenl regulations y accortlin <br /> ¢ Ii I am a large quantityy 9 to applicable internal a-_ <br /> O to De e<onomicaa generator,I cattily that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have eerem.r <br /> Y practicable and that 1 have selected the practicable method of treatment,storage.M disposal currently available to me which mw-,res <br /> Pressor and future threat io human health and the environment; <br /> = generation end select the best weals mane OR.it 1 em a small quantity generator,I peva made a good faith egos to minimise m, �e <br /> w gement method Ihat is available to me and that I can atlortl. <br /> U he <br /> d Nat •save <br /> W1 �} 1 ...� 1 Signature <br /> Month Das yea- <br /> w N 17. irenapor... I Acknowledgement of Receipt of Malarials /;��i <br /> Q A Printed/Typed Neme C. V <br /> ON Signature <br /> F ..j ra f:t �.. Hc'/� � C C -� Momh 04. yea- <br /> rtu N 18. Transspo 2 AcknoWedgemant of eipt of Materials <br /> U T Printed/Typed Name <br /> Z E Signature <br /> MdnfA .a. -yea <br /> 19. Diaerepaney Indication Space <br /> F <br /> A <br /> C <br /> T20. F4ci4tY Own or Operator Cenifical- <br /> f receipt of haaartlous materials oovWe <br /> V Printed/Ty ma manifest except as noted 1 19. <br /> Th A ,wl Si9na(Itr <br /> xe@T //� � MonfA La. vas• <br /> DHS 8022 A(1/BB) +._� V/Y <br /> 'c PA 8700-22 L Do Not Write1711 <br /> ;Rev.9.88)Previous ttdition, SOW niis LiOe <br /> FEB <br /> 15 <br /> -41lyasi <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />