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10- 2-06; 4:49PM;YELLOW ;913 344 3614 # 3/ 33 <br /> F Aug 28 06 11:27a Julie Huber • 2&8-3880 p,28 <br /> Farm App.ed OMB No.1050.0039IEeplrm 9-5099) <br /> PlSee Instructions On back O{ <br /> evic prM er y'p'-fomr dtd9Mdkr um on:lib(12,pikhl yp.r+rlbr. � Page b. Dnp,nmeN of To.fesubatmcm Ce.re <br /> UNIFORM HAZARDOUS I, c.n.rma;,us EPA ID No. Svcrememn,Col,E.mb <br /> Monilel DacvnI No. 2. Pope t Info•mmian in ehe shaded mroar <br /> WASTE MANIFEST C: P, d O 0 Y) g ,,, / .j A] CI ( i 4w regv;ved by Federal leu. <br /> j S. GeneramrS Mameand M.i lop Adds» N i I= ) itelA A. Sic!,Manifel Da ,,.,Nerbe• <br /> El.n rtox 340 2 2 S 6 �+ <br /> o DELI-R. CPtm3Iii 869 c <br /> '^ P. SI Gawrame.lD <br /> ^ 4. iIac mr7 Pbone$Q{.) j;(j/v^IIIiT <br /> 3. Tr.neporhr I Company Nome 6. US EPA ID Number <br /> m C. Shle i.nmponeSlD lhemLmd.t <br /> AtP.tER1y.:AN VJ1LLi:Y MtI1},YI•E OIL. C. h. L U D [) $ " Cf i' ;i _ <br /> S r D. Transponah Pb ,2 - <br /> f �� 7. iransporhr 2 Cemperry Nome ,r <br /> R. JS EPA ID Number E.stale TremporteiNO fR®m'ed,l r <br /> to V' Ie�pt�pa� :. Tionrp-Nei s Ph-rm <br /> �Q 2 0E'TvIRIK -P��y Name on h5 �edrex 10. US EPAW Number <br /> G. slme Peri iyelD <br /> -� !J;UM CLAUS KOAU1'�tlA .r A I.. ES +'9 9 I L A p; <br /> r 0. o H. Fenliy4 Phone <br /> s T'•rQ f'UV!_t'RE3rl.iiS.I:A;fJ:nE! <br /> NI— k3 A L 10((, K) 1 ii C)'3 1 G 20111-$©3-131131 . <br /> V11. 115 COT Dewiplion lincfud;np Proper Shipping Nom.,Ilazard Clasf.end ID N-mbarl 19. Conminan 13. Teral Id_ UrU <br /> Z o. - Nbi ELt OcI Na. T e Wanfiy WI I. Ware Number <br /> 1 C sMe , <br /> r2,1 <br /> 3 c �'1 <br /> r N E <br /> o N' b. <br /> m E 4ate <br /> V R <br /> A A`/Other <br /> ? <br /> i o T C. <br /> m O stem <br /> a <br /> E-AlOrher <br /> Zz slime <br /> w EPA/OMer <br /> N A AcUlfaval Dmvipliom br Mal�ids Usmd Above <br /> i USE'U GIL R V1tATE:it K Noodling Codes F.r`Nasmelifted Above t . <br /> W e. 01 b. <br /> z c. d <br /> U I3. Specid Hend Fuse lnstrwttonf and Addifienai In(ammian <br /> `R r3LaJps <br /> Z EAMEF+f: Nl^tf';1t3!2�2jt?•3t1P•8853 <br /> 16, GENERATOR'S CERTIFICATION: Iherebydedara that l+a mnlenh pf this wmi .menl ore folly and acwrtW described aaove <br /> I mcrkd,aed loheled,^^d an in olllepech in paper undilian for lrm gy phwoy p PraPer shipping nam-and.ciomilivd,pocked, <br /> sport b hi aeeerd,r b aP;,ble iemrnoNenc7- d nmione,ge Home+l repulalfo.+s. <br /> J IF I om Is larq q,rentirY generaar,I c.My rhel I hove o program in plow m reduce the volume and toaidy of week generaed le the degree I Aare delermired to be xoew�call <br /> procficoble and ekes I have w dad du racdc.1I method of vaolmeI:rare e,or di alai curranA ovai.aWs to me wlskh kir. -'e the <br /> O and the envfranmmr;OR,if I am o:moll qua,Illy Benerder,f h.mode a goad fa,ha Ifod to minimize m Present and Ivmra Threat 1.hamon 1,a.'I�I <br /> owdebla to "d That 1 wn oF64. ^ r masp Pe^mutton vnd+dda IM beu vms;e mana9emml meshed 16.1 Is <br /> 1 Y Pdnfedl/yped Nv v yT signalure / <br /> TL <br /> (D 17. TruFucurierl A,,kI of laf Mobdal+ v <br /> waI Y PrF!ed/Typed N me - sipcaNra a.,f <br /> LLvy <br /> p 18. Tram ar Ahrgwed ement of Rxei o(Mafmiah <br /> j Prinled/Typed Name Si Plwe <br /> Month Doy Year <br /> U F 19. Dif<reponry IndkPli-n Space <br /> Z A <br /> C <br /> + 1 ' <br /> 1 20. FacR� Owner e< volar UlfkWi 'rrai lof hoz-rdoun motorial:mverad I smo ' uaxce rasnaledlnlmm 19. <br /> T Printed/Typed Jde <br /> ter//y ,/-�/ SignoNre <br /> Y Vl.IA, Dar Year <br /> n r t J <br /> DO NOT WRITE BELOW THIS UNE. / <br /> DTSC 5022A D/q91 i.L. ... _ . . . . <br /> EPA 07OG-22 <br />