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Aug 28 06 11:25a Julie Huber • 20668-3880 p22
<br /> Slaw of C.Irlarnia—Emirenmo{dd Proleaiort Aganq See Instructions on back of age 6. Deponmenl of Toeic Su6nanues Conlr�
<br /> Form Approved OMBNp.2D60-0039(F�ira 930.991
<br /> Please a, desgnediw use on elite 112-Fikhi rypa..nl.c Sacromema,Calilor Na
<br /> 1. G.rm aw',US EPA 10 No. Mantled DaumensNo, 2. Page 1 Infomatlw;n,he shod.d area
<br /> UNIFORM HAZARDOUS / ,no,r.,,;,.d 6,Fedrd lay.
<br /> • WASTE MANIFEST (.. 0 l,i II ( 2' ! 1 ) 2S 9 `p of T
<br /> 3. Gene,cra, Nomaand Malling Address
<br /> A. 51.1.Manifen Document Nrsm6AIJII=IWANVA11.LlW,'stilFOIL1W 2378`'9' So'2' 7
<br /> F.O BM 340 B. sloe Generoro/,ID
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<br /> N S. TmnapeMr- Company Name 6. 'JS EPA ID Nvmher C. Slob Tramporhys ID InesRe,=.l
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<br /> oAMERICAN VALLkY WASTE Olt. A L (i b D g Lj D.Trarapc-lels Pho ei�yD•p32-4845
<br /> tD7. T'aa' orhr 2 Company Name ePmbe, E. Slat.Trontporle/s ID Res.'.d.I
<br /> F. Tramportds'Phona
<br /> q�,�n a 10. US EPA ID NumberlafP]Wi�u�9fl�y� d`N`�Z sirs Sr?IJ f 11 REVER 1273RD VJI:;i liAC;fiAORI:IdTO(:A Ofwb1H. Fadcyt Phone
<br /> W0q A L.? O4 4 U 03 � 916.37'I-5'74'7
<br /> 12. Conminrs 13. Taal :A. Ural
<br /> (Yy U I1. US DOi Deseipsion(including Proao Shipping Nene:Haza.d Cl.,,,end ID Numbrl No Type
<br /> Quantity WI/Vd I. Wena Num6r
<br /> NZ a. NON-RCRAHAZARDOLISWASTIEI-IQUID5rtih 3443
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<br /> LISED AN'TIf RETIE) 0 01 T T op v EPA/Other
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<br /> H J. Additional D ti n��jj���� ddff d Ab va K. H.'Aigg Carles Ia Wages Listed Above
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<br /> EI�1�.L-N 'LLY"G4� 42G-4(1°y4 a.
<br /> 0; WATER 79-5531 x
<br /> ac 0I1. (31-05 h c. d.
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<br /> z 15. Spedal Hand jag tr,,, tons and Addhonal Infarmalw-
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<br /> GLOVES
<br /> 1u EMEERGENGY VOONE209-4167-8857
<br /> 16, GENERATOR'S CERTIFICATION: :herwydedore the,the aonbr.b of Bis carniy Hent de fuhya,d.m,.%ydmcri6ed abwa by groper s6lp�irg terse and are chuiRed.paused.
<br /> UmaAed,and k6ebd,and are m all respens in proper oond'nion kr kamparl ey highway according Ic app ble iaernalional and nolicro gwernmeal regOolmrs.
<br /> II I an a longe quantity generator,I cr11Fy that hwa o Fm�rcm in place to reduce she rolome and,oekity of.wen gw.v lea is the d,,.I ha.e determined w be ecovamkallrr
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<br /> , t haw sdacted the ppraclim6le method o "oanem,aero,.,or disposal c.mendy aveila6le la ne whic,minimizes the protest end future irrea to It....heahh
<br /> and the ewironmem;OR,iF I am a small quantity gamest,I naw made a goad faits efforl to min{mrse my ways geieration and select,he bee,waste manapemen,m.,hed 11.1'u
<br /> >va&Icle to me and that I can afford.
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<br /> } Prmled/Tyyed Name Stgr,cbre .Wn16 Day Year
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<br /> u., T 17. Trots Her 1 AcLawled emenl>I Races I of Motedcls
<br /> RSignohre "o.11, Day Year
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<br /> Tronworlar 2 Ackwwled mens of Recd I of Malarial,
<br /> O RT Printed/Typal Nam. Signature .Month Day Year
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<br /> V19. Discrosomq Indication Space
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<br /> 20. F 'lib Owner or O rotor Cerlificolion of receipt aI 6occrdout meteria6 cowed'by this n emilen except as natec in Item 19.
<br /> T P' / dNome Sigoa`re, f Mw,n
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> Y.aa... TS FSE NDS 1-,i ;.... I:: :;E.i.ii F:_i"', ,•
<br /> DTSC 8022A 11/991 p a...,. , . - -. - • .,.
<br /> EPA 8700-72
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