Laserfiche WebLink
�a of Cplmfoma—fnymron,eenmal Protectwn Agency <br /> n Appro,*d(?Mg too 2pgp_p039(E p,r*s 9 36961 See Instructions on back of page 6 Depar+mert al T... Substances Control <br /> dP /type Sacwmenro Cal,forna <br /> sse p�slrRttrtyQlr� Form esp„sd fen f7 use on ekre rid+ svrrMr <br /> UNIFORM HAZARDOUS Lic <br /> rator s US EPA ID No Manifest Document No 2 Page 1 Informption,n the shadedareas{ rs not required by Federal low <br /> WASTE MANIFEST ���t .� ! ! C1 of <br /> J <br /> Ge aeons Nana d,�oiling Address i iS 5 a ryY) <br /> _ f IL <br /> A <br /> 5 Transporter 1 Company Name 6 US EPA ID Number Cass T r <br /> el <br /> t r�XQ3 235-1391-,;_ <br /> 7 Transporter 2 Company Name 8 US EPA ID Number E. VIM <br /> 9 Designated Factlrty Name and Ste Address 10 US EPA ID Number +q9}�1 <br /> -134 <br /> 12 Containers 13 Total i 14 Unrt 'Ti^ <br /> 1 I US DOT Description(including Proper Sh,ppnng Name Hazard Class and M Numbcr) <br /> Na T OuanMy Wt/Vol 1 wad& <br /> '-'a.:-t- -1 tri7kU <br /> Epi ; r 1 r��m, [�131� o 0 ' q oil I" <br /> N b ' <br /> E f` <br /> 9. <br /> R t <br /> A _ <br /> Tse <br /> O <br /> EPAR <br /> .r <br /> d Skft' <br /> EPAJ_ <br /> Pnafll? 3CV:--5 x <br /> "te, ..;w <br /> 15 Speaol Handling lnstmchons and Additional Information <br /> 1 <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the coniNt3 of the%consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are in all respech in proper condition for transport by highway according to applicable international and national government regulations <br /> If 1 am a large quantity generator f certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treahnent storage or disposal currently available to me which minimizes the present and future <br /> threat to human heohh and the environment OR if I am a small quantity generator I hove made a good faith effort to minimize my waste generation and select the fest <br /> waste ma mord method that n available to me and that I can afford <br /> Printed/Typed Name f Stq re Month Day Year <br /> } 17 Tram r 1 Acknovled ement of Recem of Materials ♦ 4 r <br /> x <br /> R Prmted/Typcd Name _ Signature j� � � Month Day Ycar, <br /> a 18 Trans rter 2 Acknowled merit of Receipt Of Materials <br /> TPruted/Typed Name Smgnatvre Month Day Year <br /> E <br /> P <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> G <br /> I <br /> I <br /> Fool Owner or rotor Certification of necem of hazardous en als cover th manifest a rated m Item 19 <br /> 7 mntedfWped N7w_ Segrta4i, �� /_� 1 Moet Day Year <br /> Y y <br /> DO NOT WRITE BELOW THIS LINE <br /> Ye"ow TSS` SEND -,.. <br /> !Ce eraser, Nno u t �a ❑07 s - _ <br /> CB 0222 (1/031 proev,ce con .,pmer-j -nom h s opv =r -1 c __ " - �l3C dcys <br />+ } <br />