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Oct 03 02 11 : 49a HIC 209 234 2711 p. 13 <br /> sale I cacfargqio—Emiranuminual P� ..ion Ag...ar See Instructions on back of page 6. psmen <br /> parl of lmi<substances Unit,Fam'ApprovM"OMB No.2050-0039(Eapiras 9-30-991 Sucme emo,California <br /> Please Prim oe NPs. form designed ler use on elite(12pitch(typernter. <br /> 1. Generator's US EPA ID No. Mani6stDxumant No. 2. m <br /> Pagel Inforotian In the shaded oraos <br /> UNIFORM HAZARDOUS ii noti-Nuiredby Fodmalau. <br /> WASTE MANIFEST ,'1 or <br /> 1 Gesewt Name and Mailing Address A S1pb Manifest Document Number ^ /s <br /> 2 2 <br /> Jej,;, 85010, <br /> 8, state aamarorsID <br /> I <br /> h f <br /> A. Generator's Phone( 11 s! F / <br /> N <br /> cV 5. Trumann, m l ComisanY Name 6. Us lIA ID Number C. Sher 7rmspart.fs lD[Qq rva :F �S.,C �h .A <br /> '71 sr 1{; # +': ;Ip D.hpdspoNPs Phone t F-aF Y C -'�9 o!' <br /> 0 <br /> 0 <br /> m, y Tranymrrr 2 Company Nome 8. US RAID Number E:-Elate lronsportels ID[Resened.l , <br /> F. Tmnspzr'ph. <br /> V <br /> 9.sOmfgnmfacifilif Nottand Sir Address 10. US EPA W Number G 5t.r Fal s�. <br /> •Q Ii isd (:el.i•+N•p-4i <br /> Pharof <br /> 9{'. i n`), <br /> O <br /> Q 11. US DOT Des<riptim lineldhp proper Shipping Name.Hazard Class.wed ID Number) 12. Castainers 13. Tool 11. Unit <br /> V Ne. Tvve Duan' w1Nd rW- 6- <br /> Z <br /> Waste <br /> States <br /> El <br /> 3 G I .: r i�! f .I': 115,E / _ ;yFl.� ,"N 6.ER <br /> v A <br /> o T <br /> so O <br /> gA/ <br /> — R <br /> d. <br /> sdN <br /> UEPA/Other <br /> N <br /> 1.AddiNat9lOma Fee Above . KHandling lCodes for ousters Listed Abpw <br /> 6. <br /> N <br /> d. _. <br /> Z <br /> O I3.Spsnl Hwdlitp Instructatr and Addigerml Irdaw,atien <br /> Z <br /> f <br /> I6. GENl41TOR'S rnnncAnoN: Ihere6y declare shut the wnrnr al)iris consignment ore fullyaid acwra described a6ovs by Proem shipping name and are classified,Puched, <br /> Vmarked,and lab.ld,and ore in all esteem in proper wdgfan kr tronspart by 6ighvmy aeording toapp icable inromotiorwl and notional government regulations, <br /> =+ If I am a large quanfihy genarotw, canify thm hove o pre Tom in place to reduce the whims ad unikity of week geswratad to dee degree I hwe determined to M econaniwllY <br /> H practicable and deal I have selected dee pweicablu matled <br /> .Tom <br /> srorug dispoS l sairm dy w iloble to me which minimises the pr m and hours threes w humor=I'F <br /> ad 1M environment,OR,if I am a omll quantity fiancees,I have mode a good 6A.)fort ro,rinim¢e(my wash 9.1ion od select the best wane monagement method that is <br /> pavai666 to an,and that I cess afford- <br /> Prini.d/Tvoed Name i.s Sig.,te I Mand, Day Yam <br /> Zi III, 11'. -s., �� i - r. <br /> w 1 IT' ns Traerr I mens of Receipt,i of Mauiw A Signoturo _Magh Day YearPdnted/Typed, <br /> W <br /> w <br /> it 18. Tran ear 2 AhmvAd mem aF Recmi o!Masrids ` <br /> Ohintd/ryp.d Name signmu.. .. March Day r.a. <br /> U., [ <br /> � R <br /> V19. Discrpong ldicalion Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> 20. Fccilitv O.ner a euros CerriBcmion of recei t of hascrdoas materials cwerd b this neinfed..mpt as noted in bum 19. <br /> T PrlMed/Typd Name stgnmure hionth DoT Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Disc som(1/99) _ .. .. ..... .::.I:.•r. <br /> EPA 870D-22 <br />