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I 10- 2-05; 4:49PM;YELLOW 3 344 3614 # 32/ 33 <br /> !!!€ •,.,,� _, , .41, <br /> ARD U JS WASTE MANIFEST <br /> ! D R 1A NT OF NATURAL RESOURCES ! , <br /> fi shy,/,r, AIR AND LAND PRly'ION DI'Al THIS DOCUMENT MUST BE USED FOR ALL ASSOURI-DESTINED SHIPMENTS <br /> , ' dI Hazardous Waste gram "INSTRUCTIONS FORTHE COMPLETION OFTHIS FORM ARE ON A SERATE PASHEET. <br /> "- RO.Box 176 JBtfer96h City,Missouri 65102DEPT OF NAYURAL <br /> 573.751-3176 IN CASE OP RELEASE CONrACT U'S.CONST GUARD RESOURCES <br /> U.S,COIWS GUAim AND MOLAR 1:Bgpa948862 5]3J.A62/96 <br /> plea§e Pdm Or type(Form designed for Lui on elite(12-pitch)typewriter.) Form Approved.2M6 No 2060-0039 <br /> . <br /> UNIFORM FIAZnFi�Qus 1.Generator's US EPA IV Il Manuel 2. Page Information in the shaded areas <br /> Oppument Il tS required by Stale law ,,... <br /> WASTR, ANIPP$T12 / - - <br /> -3.Gnlelawe,Name acrd Man ngAddraae ROAII14AY EXPR,I.S'.31 INC0RF'UR.AI E(I <br /> "Z"",1 LOOhIIF} ROAD ar, <r <br /> y r46Y.i Ul l CA 95705' <br /> •4.Generators Phonal 2P9> 1c562901 <br /> 6.Tfenepolter I Comparty Nal &US EPA ID Numbor - <br /> N <br /> HERITAUE TRAMSF'URT LLC: o a = r <br /> 7.11hansporter 2 Cor"InY Name 6.U6 FPA I77, <br /> Number <br /> Z - Z D a <br /> S.Tledpnetetl FebaM Name antl Site AddsIse 10.US EPA ID Number <br /> I HERITAGE. ENVIRUNMENI''AL SERVICES LI_C O. <br /> 8s2Fj NE 3e1H 5'rREET <br /> U; <br /> ` , KAht�AS CT`1N 41t7-fi d'.16t l tr'f� Ir $ 1 5' 5'6-15,3' J <br /> -11 pIST Ossdidnon(I^cMillnp;P,bfiMAhl Nems,Hazard Glees lD Number and P7WjGmupM any)) 12Contalfiery'j'. 't3. ' 1a( <br /> Totl r Una Z <br /> Nura6.r Type paantity_:._ VJWoI, <br /> LL <br /> i A .1E+ CCIRKd$kUE I[7UInS1 AC:G.I IC.1 1.�; It <br /> 17RGlt�IkGa N,p.5. 1 G;, LlN 1164, F•G11 ! <br /> r <br /> : i $UJ-FURYC AC"IC3:). ,"I ,.l ) 0 1 F ) )" :�{ , " <br /> It Y Ul <br /> fY <br /> Rt , <br /> I ` d <br /> , <br /> tre 2, <br /> 1s.®pec H gll 'I dirk^an Additional lhto-Mlpn IC G"�1� . . ('�. (� "(7 Q(/ Qr W. <br /> Ix. <br /> t&GENERATOOCERTIRCATfbN:IharoWdeelaro 1ha11hocontorise(thlsamalgvnentare fully. enowalely daeCt�Pt ebwatry praporshj7plrgrwnleandarpd�dssHleQ,peeG9a, ,witr kEaled, �.:. <br /> and ere In ae roapedelaprojlel'conra0pn'for hooll by highway accWding W apllill pdematlenal and ndddnal gdMemrnam regulations and apprpable elate regalatlana. . Q <br /> It 1 am a I91gB qual ly genarMi I o r*fh. at I haw,a program In place m reduce the volume and tmddl of waste general to the rlegi 1 here ddeaidnad to be acgnomlcaM plbcf(cahld that I Od <br /> hmeaeleped me platefulmethod of Uemmaid,Moral or dhposal currently avegable to me which notgri as the-present end ful la lr antic hranan In ant the arrvifQ0rlre0k OR,P I din a amen 6i <br /> sat"g6nAl I have made a good fall effort to Mill mywaste givaration and aeleat the bol waste marugameM melhpd available to methat I c¢tl adord Q, <br /> PrYd Nemo '� SlgnaWre :: NonBt Oay Year DU <br /> 1ArJtiiowle of - of h� rals. <br /> DAY: Year =... <br /> R P -� a. sign � / C `'.'. <br /> N 5 <br /> P.. <br /> LU <br /> p8b. <br /> .R &Tiarls- 2Aouroar idgpemot mRaL4lpt of Avatar ale IO <br /> Month Day. Year Z <br /> T PdrtlBdNYPa Nemo ¢ <br /> e7pI— <br /> p <br /> 1g.Dlelapency Ihrtpdon epees - �• / - - W <br /> mm <br /> F <br /> ' 7 <br /> rA <br /> I T <br /> T 20'CMilgnared PacnAY.Owrwr or Operator.Cartlgclbn of raptor of hazardous materials wrered by lis manliest except 96 Will In 11an 19.- Oats O W <br /> Y Prm /pad Name e - Month Day Year <br /> teNp /) Signeba / -_ <br /> EPA FORM ( DNR-MNG 10 PREVIOUS EDRIONS ARE OBSOLETE - <br />