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I 'IRM HAZARDOUS 1. Generator's US EPA ID No. Manifest <br /> ATE MANIFEST Document No. !. �f information in the shaded areas <br /> is not required by Federal law. <br /> 3. ansralor's Nam entl Mailing Address t <br /> -i <br /> f �€ A. .. ale�rManiteet Document Number <br /> a � h JJ r��� 5757 6����s�� 204- <br /> T/`44 V Gi4 �.y B. State GeRstator's ID ' <br /> 4. Generator's Phone 1� of CJ`7 f �'� �k - - <br /> ..' 5. Tra port 1 C pa Name J7 i J {> <br /> a / e. US EPA ID Number �O C. State Transportar's ID <br /> Trans14 <br /> ports►e P <br /> I. Tranaparler 2 Company Name B. US EPA ID Number ;p E. Slate T <br /> ransporter'a <br /> F. Transportsea Phone <br /> 9./nDesignated Facility Haeer me and Site Address 10. US EPA ID Numb �l G. State FaeWty'a SD <br /> 644 <br /> iKPSM�rrP� �'�.ayly <br /> y 3. <br /> C"/1 ;k k1 Faclluy'e.Ph=* <br /> 6 7' <br /> 11. US DOT Description(including Pro 12.'Containers 13. Total u, I, <br /> P g per Shipping Name,Hazard Class,and ID Number) I) 'j Ouardlty Unit Waste No. <br /> 11 1 } No. Type t/Y �y <br /> G a. VI1f�s ' r,el � I/1sctk <br /> NC jr� :F.PA/Of w <br /> E b. T <br /> R �' ._.. .. I State <br /> A {[ <br /> I TO E EPA/0"w <br /> R c. State <br /> I; <br /> IS OPA/Other. <br /> d S <br /> ' li a .Stale. <br /> I{ PAI otll.r <br /> J. Additional Descriptions for Materials Listed Above Above K!,ltandfing Codes for Waetea.l.fatad <br /> 3 I� b. <br /> li <br /> A" -, <br /> r 15. Special Handling Instructions and Additional information - <br /> I'l i <br /> li 1 - <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified. Packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> International and national government regulations. <br /> "It:m a large quantity generator, I certify that I have a program in place to reduW the volumel�and toxicity of waste generated to the degree I have <br /> dermined to be economically practicable and that I have selected the practioaWe method of treatment, storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment: OR, If It am a'small quantity generator. I have made a good <br /> faith effort to minimize my waste generation and select the beat waste management method that is available to me and that I can afford. <br /> It I <br /> Pri ad/)rped Name Si we ,,, <br /> / IMonth Bay Year <br /> '- <br /> r T 17. Transporter 1 Acknowledgement of Receipt of Materials , <br /> r R <br /> A Prince pedrama <br /> IL <br /> Signatur Month Day Year <br /> N <br /> S <br /> Ie 1 j <br /> P 18. Transporter 2 Acknowied <br /> O gam of Recaipt of Materials <br /> R Printed/T <br /> T YDoc Name ] Signature II A#wth Day Year <br /> E <br /> t0. Discrepancy indication Space 16 <br /> I <br /> F <br /> I A 16 <br /> I C <br /> L Ik <br /> 1 20, Facility Owner or Operator Certification of recelpt of hazardous materials covered by this manifest except as noted in Nem 19. <br /> T Printed T <br /> Y yped Name Slgnstur , Month Day 1�gpr <br /> S eons A(1l87) II INSTRUCTIONS O THE BAC <br /> 8700 -22 Yellow: TSDF SENDS THIS COPY TO GE OR WITHIN 30;DAY5 <br /> ;v.9.99) Previous editions are obsolete. <br /> I iI <br /> rF <br /> •e <br /> I� <br /> i <br />