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ftlf$ol C41110e90—Health and Weft*AgWVV dm"NFdMAaaol dOMef x2060—=9(E> 9-30-91) ! Seg Instructions on bl, v Bayo 6 . T S�ueuommContmlwoogtc ROM pint a tye.ptam WSOMod kY we al oft(f 2.0 al 9xalw dv.Cwear UNIFORM HAZARDOUS 1 Ge rrcno'I b EPA i0 No Monlwit Doc,.nert 2 Pape 1 k forrnotbn n tiv thoded alto WASTE MANIFEST �Q G !� I` r I h 1� T of" rrotmQukwdby4dealow. .a Ger»raoh Nome and Maerq Address 1\ Ar Slpl�. C �r�l m11h :.t.7n '.�I`hY .,7 ; ! .t.l•e v7 1^ I.1 .I� ' rA..C):'�L•Zl r. oa�`Y�%�{u, syfi..JrnkyS L � yy 1 './•1..1: t rl_Z` .•T. Y 7n 2 a .>K'a{ .5 ?Pa sK�, �ienNat0�1 Yr10f1e( ) r. >.�<@• y �` > ' �s'2'Y•�y T ax...v0-:�^:Wi;{ E 1: .t.....1.3�.a.E. .i:. ::� i... '. •vi, i• S.Transporter 1 Compory Nome 0.lA EPA ID Numbef : _ .y.�. 1- / 3rIpQISlI(iE V7f01'tr :rUL .. 7 k:... ; 7.Tronsporten 2 Company Nome S US EPA ID Number k>h;3 QC1'Tl#11Q.6.Mr1 IP:<:%<; '"! w"'::::<>E»>?::Yt.::: ...y; ya,:a,?<•,.>:%f': I 1 I I I I I I I i I F Ttareeyl : nA < ' govg p�d•Fdcllty porn Qnd Site Address 10 US EPA ID Number i;Ll�jii ciYCNI JC::.Iy t�.n. .2oE^�"'�r'•'ts'�...tlk �jP 1<' r i s.0- ? L T' 'i (i•%1 f.A' t! r�•r �.1.... �. 1 •I I /!o sy`yi s ..a... 3: WDOL Detcflptbn(kCklOng oW bpkV R r Sn 12.ComQnen IS Tota Ie.Urw 11. Name.Hmam Clop :Yn iU NumaJfl �• No. i Ouont' Wt/Vol '4 Wad/tVlxnWr CL nU E O j Y IT 1 1 s E b. l.►J i4 sTE -soz. � ::: > n. U : T C. z; '8QY f1QdPW t 0-E et101F AbOye : K,, C CR ANa YR v. Z < 10.Specld .. .... . (,) HOrlaMlp InnruCfbns ad Addttbhal iM0/fKTon !'Ice �C•... �r.�r IC'1 t• :' Y 1 y . T'.L': :i ''.i4 .i �Y� W Z 16. GENERATORT CEIMFICATION: I hereby doclofe Incl the contents of tho Comign tnent are fueoo y old ouashlp Ny descrbed oboyn by proper pkq nano and an ckxsftd. z packed.rooked.and labeled.and ort n d aspects In wooer cordnbn lot trompon by hlghway abcordhp to oppkoble ntenlalbnal and rotbrol goytmment mQu o tom n 1 ort a large QNOatlny gtfrefaof,I Cert1y irxr I have a pmgrom n pact to foavc#the vokxne old taxleny of wade generaed to the aegret I hat Oeto m od to be Zeconomraaey ploetk;Oble and n<a I hays wleerea me PrOctcCow n othod of tmament,dorage,of disposal eunenlly avoe0ae to me wnk:h mn)mtM the present and future IMtol to hwnan h*Wh and Ma onvtorwrwnt;OR.1 I am O troll Quafliny genefow.I hoe made o good IOnh effort to mnkntw Ry wade gtheabn aha Nlect the bed wom �t monogemoo Method that Y a4oVMI0 to me and tna I Can altotd pmted Yped NORMspnotvt Monro rev J �7 2 C T 17.Trom Porter I ACktow•ledgernent of Meeipl d Maletoa O R Pmad/Typed Name Spnc no Month Day Yom > A Z p O IS.rromoorter 2 Acknowledgement of Rece t of mcromttl R Prntted/tyPed Name r Sgnrnwe Month COY Yea W T O E �s R I 1 1 1 1 UF 19.Daerepancy nacalon So=@ 3 A C I L 1 20.fO:Any Owns or Operator Ced'lcrnion of mceOt al hat0t00w nlaterloe Catad Oy this mOnitst except Of noted n nem IV. T Pmted/lyped NO" Spnaure Month OCY rev y r 1 I IC71 zi DO NOT WRITE BELOW THIS LINE. 0 saMA<12770> Green: HAULER RETAINS EPA$700-22 1 .