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V0 7( <br /> f I ,Or N LOUISIANA - /' rJ <br /> :.I'- A Or S WAS <br /> DIVISION QUALITY <br /> 4 Lf1RUO P.O. WAS 44 UIYI$1(lN <br /> / . BOX M307 <br /> fCON ROUGE.LOUISIANA 70804 REUSE/RECYCLE JAN !. 9 1990 <br /> r rannt or ty?e. (Form designed lot use on.life(12 pitch)typewriter Form A A' <br /> pproled. OMB o.2050-0039,Expires(9-30-91 <br /> UNIFORM HAZARDOUS a generator's US EPA IO Np. Mani�st 2. of Federal normauon in ma shaped areas <br /> WASTE MANIFEST (V�UN Vn I{ ' I iaw�ol required by Federal <br /> 3. Generator s N.me an ai ,ng+1�dre1_ssA. <br /> I ��y 1 �! 1�''V U�.G.. /1 Q'�, ORIATION l� OV <br /> /1 tate/V�a"-n�i/eaT-i Document Number <br /> 5`rb�KT�iN,GAut C7tZNiR gJdb 0 37�21 <br /> 9-tate <br /> enerator <br /> 4. Generator's Phone (ap 1 e -1(015 0Oba� . <br /> transporter ompany Name U PA ID Number anspunars ID <br /> GSX' Se r✓I'ra { Ca I I (von w � �D S Q <br /> r G ster s Phon ( 7 L. <br /> ransporter ompany Name U EPA ID Numberensporter'c <br /> f <br /> ransporler'a Phone <br /> Drip?a acility Name a le Address 1 U EPA ID Number <br /> �f � r.`VL�S`�N v�,r.. / tate Facility's ID <br /> c owl. LA, 7n5a6 1V 5 acilily's hone <br /> O 12.Conte iners 13.. 14. <br /> 11. US DOT Description/Including Proper Shipping Name.Hazard Class,and ID Number) Total Unit I.' <br /> No, Type Ouanlity Wt/Vo Waste No. <br /> D a. gsT��PwP4-r � A -Ev MlpITEgiryl. A) I X103 <br /> E <br /> N FiArnrnRR)L-f— Lill4fu NfO"5' {�05 <br /> A b. <br /> - 6 �oa3,R 'W <br /> n 4F'. :u R <br /> R � K <br /> C <br /> 9 <br /> R ., <br /> 1 ��q if on <br /> raol? ons or <br /> iv ?U�rC,L�t1A bays, ,. <br /> . <br /> eso <br /> �., K.Hantlling Cotlea Ior Waste.Listed ove i, <br /> Reusc/12ecycle G'S <br /> �3JpS Pfl�wr5L n6� XMC- Paly —�� X.55 <br /> i�►NS VA wVsAmottQ�NTS OF 6-sXMicT Pozi 0X55 <br /> C�QI, CSiNSAp D CIsTON�s . SchfcPu. �e tonrj'rrngNoffCC <br /> . , Mk . - n. PaoapUO q <br /> 15. pecial Handling Inst/uctions and Additional Information <br /> If spilled in LA contact Louisiana Department of Public Safety Materials Unit 504-925-6595. <br /> Wear goggles, gloves, and other protective equipment when handling material. <br /> 16. GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by <br /> proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway <br /> according to applicable international and national government regulations. . <br /> If I am a large quantity generator.1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and <br /> future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my wastegeneration and select <br /> the best waste mans ement method that is available to me and that I can afford. <br /> Prlinted/Typed Name r� f ((�� Signature ('7 / Month Day Year <br /> Chuck uc K -P CM Ff? IIMWbLS Cu m ,/�/- V A Y tea° �r -�+.( j t/ ( d <br /> N17.Transporter 1 Acknowledgement of Receipt of Materials <br /> P /Prt t° o)/TypedJ ar^� / C Sign re L Month Day ` Year <br /> 0 18.Transporter 727_AcknowledggeTem. <br /> R of ceipt of Materials <br /> EPrinted/Typed Name Signature Month Day Year <br /> R <br /> . iscrepancy Indication Space <br /> IF <br /> C S_ <br /> L VOLUh:E AND CONT'7-PITS S11f31ECT TO FINAL <br /> T20.Facility Owner or Operator. Certification of receipt of hazardous materials co is anif s ep 9, <br /> y Prin d/T ped Na a Si natu <br /> �� n g Month Day Year <br /> �/ L J <br /> PREVIOUS EDITION IS OBSOLETE <br /> EPA Form 87nO-77 fP,nv. q,nP1 n�in(n,l-nrn rrnrv-rnnnr.f-1, +..n v_tt.., n. <br />