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FUG-21-2006 1Z:32 M HWP 5-7 c5 52158 P.@2
<br /> GYRI _ I ePlLl'10 11/V
<br /> NT OF NATURAL RE RCES
<br /> A DIVISION OF ENVIRONMENTAL OUALITY THIS OCc'uMENT MVST+ D FOR ALL MISSOURI-OESTINED SHIPMENT.
<br /> t. rl Hazardous Wailto PrOgMM INSTPUCTICNS FOR 7HE CO}APLGTICN OFTHIS FORM ARE ON A SEPARATE SHEET.
<br /> PO.BON 17o Jolremon Cily,Missouri 05102 I DEBT r..mn,wl
<br /> 570.7674176 EMERGENLy I .:J3T 111JPd LMEMTRCL pEi:LPL'c9
<br /> PEflPOMdE I f�naa+f.+W:] 1Na0+Tk-0ace a-1yy;may,
<br /> e nr.nt or'red(Form dBalgrfed for we an 91aa(12-piton)fypwrder.) Form APpmved CMB NO ZUSOAJ009.
<br /> UNIFORM HAZARDOUS cenoromrs us flag IO Np. Man lea{ B. Page— IniormallOn in the shacetl areas
<br /> pxumam No.
<br /> WASTE MANIFEST p a ter Is reGulrad by Stale law.
<br /> 9.Ceneraloeo Nameane MaI109 AadROADWAY ESS, INCDSFCRATm 1_rea8 +li: — ■mt. oiler
<br /> f d,_ ;
<br /> 3233 LOOMIS ROAD
<br /> i.,
<br /> roar -
<br /> STbCftTC1i CA 55205 N.dal.
<br /> jq-
<br /> u.Generator;Phono( ) r• f-�- r
<br /> 5 Tlanepomor 1 Company Name B.U9 EPA 10 N�menr C:),10 µ%"c k.`;;C$' �- F
<br /> 7.Laneponer2 Company Name B.US EPA Io Mai rE:NA7 _ }y jfT„��• ~•� - a
<br /> a _ }
<br /> a.Designated Facility Name and Site AadTeae 10.US EPA 10 Numwr
<br /> HERITAGE ENVIRONMENTAL ERYICES LLC
<br /> 8525 HE 38TH STREET
<br /> KANSAS CITY 190 64161 0 D 9 8 1 A 6 8 6 6
<br /> '11.US DOT O.aalai0n(Inewdng Proper shooting Numb,Nord C&I ID Nu df and Pecamg Oreuo(it any)) 12cenlan „17:, 14.'
<br /> Numoer ryve
<br /> Total Unit
<br /> OToal IWUit
<br /> a RQ, WASTE FLAMMABLE LIQUIDS, N.O.S. , 3,
<br /> UN1993, PGIII (PAINT) ERG *128 ;_yr;' r
<br /> G D 0 "'
<br /> IN n. , , TOXIC, N.O.
<br /> S., 8, UN2923. PGII (CADMIUM HYDROXIDE, f-' N
<br /> R POTASSIUM HYDROXIDE) s-RG *154 0 1 0 3 0 P r
<br /> A
<br /> Q
<br /> I 1 h•I: a!M Fv -
<br /> d.
<br /> }.e(OEplpgpl{l�.Rpr�!W19v IW 1�p %i'"�J:4;''.§,� 'Di"• ;i.+'.`r;�.'3"braal�vT3 T.rSl'�;� "<: - -
<br /> f', M'roe v i` VII.t�' , +,ter• RQ' Int �SlL x6,uc 4W;». Ta tty) )-.'`- + 4.0
<br /> 1.11P YRSt1R' i� fJ,Au,Saf ..1cd^anF'i.^ _ ' �S�my}t�E' !, �1_'-'F•i.:".3 ¢.
<br /> 7 ,•,',t� n d Ammonal nfamst.o, IM.J�.'�"�' 1• V 3q W o q
<br /> 0
<br /> b. 105-391713-8
<br /> Emergency Ftrne-* (800) 325-1221
<br /> � T
<br /> fa.me are In
<br /> In pr cer cor arabyilf for
<br /> by
<br /> elInto ngmlgnmanlare full an eaOand National
<br /> ed overnmweygreeeranland$wI aentls' cuM9aerift. d,marked.mandutl. m M
<br /> dna are In ell reopen n proper edndlllan lar ttanNart by nlgnyray odnONing'0 epplpeale ffiernelana end nalonel g0rernment nguhlldn,and ooplldalea 0oa rcgpenene 2 m
<br /> e t en a:arge identify gw.ramr,I comity na have a pogrom m ado,ro radoca na volume end to chin,of waste generated To Ute cagres I have danrmined 10 1>•WnWlglly praalnaele and na 1 O r
<br /> have selected 1ho promita le"Mod mtreetmem,AMP,ar fir, el currency aNillable{o mo wnid,mMlmlxaa tN pnaem end diwee unroofed humor heats ondme enmronmenL OR.II I am a,map C 2
<br /> quanety generator,I haw reale a fil$an Olumonmvlp my w..1e generation and ache,the best wanemanegamem 1peqhud ayallago IP ma 1ha I can Al Qw
<br /> Pante Name
<br /> l/ J/Q� 91gne¢re March Day 'Aw 2 H-
<br /> /� ✓V a7.a
<br /> 2 O
<br /> -1 17, a nor 1 Acknowioogemont a Reaelpt a Masala Data
<br /> Adrryo Noma S'ifmaluvii j Menm De!' ~
<br /> s"
<br /> P� Y
<br /> DR t B.Tmns9orter 2 Aaknedeagamam al P....dl atergia Daft m O
<br /> PnmeNfyPeo NRr^o Signature NlOntn Oay Yea! a+
<br /> +~i C
<br /> R i 1 I N
<br /> 19.Diacrovarw Irpgallon Sgac, aJ =
<br /> ma
<br /> P h. 6
<br /> A _ 2
<br /> C ^W
<br /> 11 }p
<br /> ip.Bde...leg Facit,own.rcr o......Centli,,.n arocomtcl no=,..:malPllile CPVTaU Jy mid meO�IBa NIR•90139001ea la llaYr lB. Defe �� 1.
<br /> P.m•.d/T'Fad Name Slgnavr MPnm Dey War U
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<br /> EPA FORM 970022{(REV.1-991 MONR-HWO 10 PREVIOUS EDITIONS ARE OSSOLUTE G;VT41N6 50%RECYCLED PePER WMIf.M
<br /> NCL'.'DE9 NOT LESS TRAN Tett. POST
<br /> CONSVMERwASTE,
<br /> TOTAL P.02
<br />
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