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<br />perwrtmcnl elle%IC S+.bsto.+ses Cn.+rn
<br />See Instructions on back of r 6• tlnr....,ent,,, �ortornio
<br />,oto of Colilom arEAvironme reel Protection Agency -
<br />orm Approved OMB No. 2050'-0039 (Exp;.es 9.309A) wrir«r. — -- — — _ — — _ Infuimotien in thrt shaded orew.
<br />iwss print or Mpe. form des%Qned for use on *lite i( 1.? tYp" — _ _ �. POO. 1 ndcral low.
<br />_ Mw,ifesr VocumGnt Ne• t es not ra�uirad by F.
<br />• }, pencrotor's US EPA ICs No -
<br />UNIFORM
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<br />UNIFORM HAZARDOUS '1 N ) of
<br />WASTE MANIFESTN
<br />A- •Stale Manifest MOAN erel Fhsrnbei {',�
<br />3, [,er,nro,6r s Name and Moilinr3 Address
<br />j6y 0, Slate C,enero+or s ID
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<br />.14 4. Generator'% Phone (/'-� ) 3,�% G. Sro,eRlOMrarters
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<br />11. t15 DOT Dosrripl on (irsrluding Proper ShippinO — — — _ — — —. _ —
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<br />20. Facility nwnai or Uucrrnor,Crrtificatinn of sq,;ri t, of hnzarJO,ss mplerinh c4+rred� this manifnts e�rept,nf noted :n Ilrn_t;r- .. 1} '
<br />Mon ray
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<br />Prin,djTyprd No e _ / �,• ' ,i .r" / �,•• i 'err -_ l
<br />DO NOT WRITE'BELOW THIS LINT.
<br />CSe.;rn: ILWllk k7.Ia::•�,
<br />OTs% 0027A (7/07)
<br />•^^-'"•^""— K,Fiandting Cndet for Wastes Ustorl AWvo
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<br />15. otial Honcilin lnstrudions and Additiorwl Information _ —8-14-4444
<br />l��iL"ItGE:r't:Y CONTACTVW;
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<br />,44 %``II=RGE';i;Y Ckwl'O?:SI=: INC.
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<br />APFCtOPR1ATF: PROTECTIVE. CLOT111.1I0 b is F. SPI'LiNEC R.
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<br />16. GENERATOR'S CERTIFICATION: I hereby declore that the cc.ntents of the Lon%ignmrnt are fully and wnrrotnly descrdied obnve by Me t"r Shipping nnm� and air rtassi6ed, r
<br />far transpoA by highway according try applicnble farinral, Stntr. and inlrn,n,ionSJ law:.
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<br />Packed. vu+,kcd, ami bbeled. and 0- in oil respects in proper condil;on
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<br />nti naeralOr, I certify that 1 have o program in place to reduce the volume and toxcity`n''v`'cY`?hiblrgenCs smnev,titod
<br />1 large quo H G t or die osn Y
<br />�rh no the rnir.:N•eshhenp.rennsrer.rl tuft♦'•`.
<br />If am o
<br />economicolly practicable and thee, I have selected the procticable meAwd of hrotment, i orage, p
<br />OR, if i am a &mull quanl;ty generator. I have mode a goad faith effort fo minnu;rc my
<br />waste g •r nernfion ,n,d soled the br
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<br />threat to human hcolth curd the environment;
<br />that is gvoilohle to me anit—!.— thin Ilford. ,— T^—••
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<br />orgesnent of Receipt of M.pytored/ransfwrla
<br />2 Acknowled en+enn t of Rnreipfrrnth
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<br />Day
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<br />Nomcpiscreponcy
<br />bnitcatiun :>p�ce�.. .
<br />20. Facility nwnai or Uucrrnor,Crrtificatinn of sq,;ri t, of hnzarJO,ss mplerinh c4+rred� this manifnts e�rept,nf noted :n Ilrn_t;r- .. 1} '
<br />Mon ray
<br />Sig�
<br />r..tl+re�''✓ ` / j r /
<br />Prin,djTyprd No e _ / �,• ' ,i .r" / �,•• i 'err -_ l
<br />DO NOT WRITE'BELOW THIS LINT.
<br />CSe.;rn: ILWllk k7.Ia::•�,
<br />OTs% 0027A (7/07)
<br />
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