HIM
<br /> Se+"• ".`'^app''^ - a�- - `�•'
<br /> �'kir• ^,'L-ra s. rw.� ' k "r" •
<br /> MAC
<br /> 01
<br /> ,ty�� q,,y: � R k�:�•e -�.y�v.� � ]t fie
<br /> IM
<br /> s µ,;iYeY > y5er ,,� tlSr .37.k I i Y. •jin ,r -f, yF
<br /> .i3y,'y.' T c- :^•Ti- fi A. i '% .y'M' - u^4'.' w5:;':_• .'roT
<br /> S Slate or Colilomis-#in%oh and Welfare Agancv Gn .,tmenl nr Nwn4h.^••,•c
<br /> Fo•m APprc,ed OMB No 2050-`1019(Erpire•g.3D-gt) See Ing and Front
<br /> on Back of I`:1gO 6 —c Sub.tancea Coalml No,
<br /> and FTont 01 Page 7 r�)�r v„�.,m,nl31CAW
<br /> Pl.av DrA!or type. Fo.rn dnagnrd rw vee on elite(f2pilch ryDewnrerl. _ I [_ 1 J,-1 1
<br /> UNIFORPIA HAZARDOUS t-Oaaeolor■US EPA I{]No L1nmw,1 ? i na� snit•`` nan•r in Ihn shndnd„res- -
<br /> Dnrum.nl tre
<br /> WASTE MANIFESt . oq drnd by Fnd+,rtl hr
<br /> S, Oanaaler a Name and Mn,ling Address / �� A. $I.M nilnal Document Ito -
<br /> ;,.+,G.neralnf a In
<br /> s. nar�p�r�rlQ11.J .4 . zo7 `
<br /> o S.Tranapoder t CmmFany ti me 6. .5 FPA 10 Nnmb,r C. Srnln 1rarepwrwr in
<br /> n r . 7F�3
<br /> OY-R
<br /> CP
<br /> 7. rranapaner 21'—pony Ame / US EP w NumbM E, $tele hanagOr r^T
<br /> OF tr rin.Part.r.t'h me
<br /> v 9.Derif
<br /> gnatetl Fnrd,ly Ilam.and Silo Address 10 US EPA lU Nur.+bnr G. Slate F.c-llly'a 111
<br /> J Eriekenit. inc. �JaII .---
<br /> 255 Parr Vlvd.PH
<br /> H .r,tlrt e
<br /> O I7 T;nnlA inern 17 101:1! !A I.
<br /> (n 0 11. Il$OOT Bwlrrrrli"Ihirh,dlnq Proper Shipping Nam.,ti.rard Cl—,and to 11—h-11QvA,ht. .nil Wrrte Nn.
<br /> NO type ttiuVol
<br /> J Slate
<br /> +oI J4 "Waste Empty Storage Tank _ 512
<br /> r" EEPA/014m '
<br /> V 3 N AW-PCRA liarAr �_
<br /> (3)
<br /> NE
<br /> h, v"''..v. Stele
<br /> A
<br /> m T LPA[Olhor
<br /> Stela —
<br /> ' EPAi Chhof
<br /> d
<br /> F- State
<br /> x
<br /> U
<br /> EPA1O1her
<br /> U, J.Additional OeacHotlone for Matedele Llaled Abs" K.Handbag Codes for KARles Listed Abo.@
<br /> V a. b.
<br /> Qt;1a� Empty storage Tatfk s
<br /> M � � : Tank (a) him been inerted W
<br /> i Vrr Ice per IG00 Gale Cmpatitya
<br /> 0
<br /> F 15.Special Itandllnq Intlmcllona and Atltlllloner Intgrmatlon
<br /> L
<br /> � XeeP away from olources of 19nit.lnna All-rax4 'Weer hardh.its whrrn working around
<br /> MaTa Te 24 Hra Contact Name 7,5
<br /> 4 16.
<br /> U
<br /> OENERATOR'e CERTIFICATION: I hateby declare Thai the cnntenls or this cOnslgnmenl ate fully and.certainly described nhnve by proper.hipping name
<br /> 't 1 and are clesslRwd,pricked.marked.end labeled,and are In all respects In proper condition for transport by hial—y Ace elinq to nlmhcnble knlernMlonnl and
<br /> a natlenal govwnunnnl rwdalallona.
<br /> � ff
<br /> 111 am a large gvanllty 9eneralM,l Certify that I have a program In place to induce the volume and Io.icily of wanre -led In the degree 1 hay`determined
<br /> to be sconomicnfly praeriCAbre ahnnd Thal I have.asci ad the predicable melhod of heelmanl,Dior@go.or disposer cunrrllrr++lly era,l,hle to ma which minlmlrea the
<br /> Present and lulure Iat to humeri hasllo and the environment;OR,it I em a small qunntlty genera
<br /> tor,I hero mAdn A good Wit,etrnd to minimize my wnate
<br /> l U genstalion end snlact!tie best west@ management method that Is nveuribre to me end that 1 can effold
<br /> r x
<br /> to PrIttedr Typed Na— 51I➢ewlVre Af-1h Flay font
<br /> w1 1 -1 4 I 1 !.'•ri r- r
<br /> I IT. Transporter 1 Achnowledgemeal oI Receipt of Materials -
<br /> = A Prkrl sped Neme Sig r k(unrrr Day ya.,
<br /> N
<br /> O D
<br /> tv 0 16, nnapor r 7 Arknowledgemonf OI RCc Ipl orMalarlslo
<br /> q A Pdnbdl Typed llnme 'Sign.lwe T Afonrh Day tent
<br /> V E
<br /> S I
<br /> 19.Dlac,opsncy lndlcalron Space Cry -
<br /> ���� 1
<br /> 1
<br /> L
<br /> 1 70. rocihil,Owner or Opnr.lof Ce, Ibat n of rae.lpi of hazardous baleriaia cdvofjay this man-fell e.rr f as nolno.n IIA.19 _
<br /> i
<br /> yPrinledl Typed Name I Signatur / ��r p-� ��., Lfnnih(lay�F�r.
<br /> cr
<br /> D119 8022 A Do Not Write Below chis line l 1
<br /> EPA 8100-22 f
<br /> (Rev,15.80)Prevtove edltlorr.Are nb o,aln
<br /> ( ..II. trwr.r �I..,. nrM,r , I•.r•nlTp+.Tnf!:YIII11))7n I:r
<br /> . CTION or THIS _
<br /> DOC r c� s
<br /> ,. DUF To TM
<br /> QCWITION or" TEGIIyAL,
<br />
|