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7 <br /> '.i I'F:OF I,OIIISIANA J r�. �// <br /> a8%( <br /> -,I f OF ENVIRONmElfrAL QUALITY �J��" <br /> 6AIIDOUS WASTE DIVISION <br /> / P.O. BOX 44307 r� <br /> frON ROUGE. LOUISIANA 76804 - REUSE/RECYCLE JAN 1. <br /> print or tyje. (Fcrm designed for use on a r�-pitch/typewriter./ Form Approved.OMB leo.290501-299oExpiresl 9-30-91 <br /> UNIFORM HAZARDOUS jj eneralor'suSEPAIDNo. Manilas, 2. rage t normatron in the shaded areas <br /> WASTE MANIFEST C DU4 Q y ' �o, 4 I of is hot required by Federal <br /> 3. GeneratorsNamean aim ass late Manifest Document Number <br /> Po�ac 103955bit`7`K N CAUF�NNIR g5 o60-702 190 <br /> �J f�,v,,,tate enerdI <br /> 4. Generator's Phone I I [) -11015 GF"Q' 00W617 <br /> 5. Transporter Company Name ++ L �U)S EPA/ID Number fateTransporter's ID K a <br /> GSX Se rvl'Go p F ��I I 1 U�/I t (A 6 A D 1S 7r 5 . ranspo ter a Phqn V1 L. 4 706 <br /> 7. Transporter Company Name U EPA ID Number E.State Trensponer'a I <br /> P.Transporter's Phone <br /> asig a acilny ame a 'te Address U EPA ID Numbdr tate Facility's ID <br /> � �� ;�a <br /> (� cdiry's hone <br /> G ovule Ll la 7n5a1� 0 5 '78 <br /> 12.Containers 13. 14. <br /> 11, US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Total Unit 1.' <br /> No. Type Quantity Wt/VoWaste No. <br /> G a. gSTE PAiw,r I; ATep M TEAIFg j.. x)/4 I gln3 <br /> E �5'R <br /> E GiArrt�ngwtE k.►y�tx NIOIs. �� (� F003 <br /> R b. <br /> A <br /> T <br /> 0 R <br /> R <br /> d. , R <br /> 3164 <br /> IMF>qq �Lq yy g Codes For Wastes Listed ave <br /> 0000 <br /> 15. Specialty 'r r//t/ ,{1r <br /> If spilt �F��/� 29 :ia:Ls Unit 504-925-6595. <br /> Wear gol �9j Fij ,1 c> naterial. <br /> T�sF`�T9! <br /> 16. GENERA 'rG' bed above by <br /> proper shi t r ,port by highway <br /> according •{ry <br /> If I am a large quantity generator.I certify that I 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,l have made a good faith effort to minimize my waste generation and select <br /> the best waste management method that is available to me and that I can afford. <br /> Printed/Typed Name <br /> S�natuure n I / Month <br /> Day Year <br /> CA uG —P e,,, a VP ( <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> IF id Name <br /> /T eSiB n re <br /> L Month Day Year <br /> B //?, <br /> P r C <br /> 0 183ransporter 2 Acknowledgeme t of ceipt of Materials <br /> 7 Printed/Typed Name Signature Month Day Year <br /> E <br /> R <br /> iscrepancy Indication Space /q7y�^�'.-(- Q - # W <br /> F •� u(�f.CLF.. ��/ 70 IP �" //'7/FOP�.-2'LLL �I <br /> A �UY�/a 3 �'p�ly G4� 7 �/� 7/F , <br /> C Wa�r� caS- <br /> L VOLUME AND CONT'F.PITS SOaJECT TO FINAL <br /> 7 20.Facility Owner or Operator: Certification of receipt of hazardous materials co is adif s ep <br /> y Prin d/T ped Na e D Signatu Month Day Year <br /> PREVIOUS EDITION IS OBSOLETE <br /> rea 1— rtznn_vo 1.— nront 11..r 1_.. 11 <br />