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FrP. 002/008 <br /> NIFE S- T <br /> NO"AZARDOUS <br /> Pease prinfior.� e ;(Form deatgned;for':usia an.elitp;(12:pttchj.typevti+rit+�� <br /> ,>1. , . .. .. <br /> 01 -t�lA " D:C i1 S <br /> '1':Gener6tor's-USS.EPA..ID'No.. tvlati"rfest 2•Aare t <br /> _ `. S Document No. <br /> y. 3:'.Generator's:i�latng$nsi�itall�ng.Adiirass; <br /> 4;Genit <br /> nerator's..-P.hone;: :92. 5,,� <br /> 6 TransporterA'�Campany'Name 6. US I=PA 10 Number Ay State Transpprter's ID <br /> ' '.': S.Transporter 1 Phone <br /> 7.Trans 2 Compem:Name Si US EPA ID Number C:State Transportees ID <br /> D.Tran,sporter 2 Phone <br /> 9.E),&§igneited Facillty Nan-Ad.and:Site''Address 10. US'EPA 1D Number E.State Faallity's t® <br /> t � XT <br /> �. <br /> F.Fsolllty's.Phone <br /> aw ; <br /> 11..WASTE DESCRIPTION 12. Cbntainers 13,' .14. <br /> Total Unit <br /> No. Type Quantity wf-Nol. <br /> ARM.,. <br /> .1 <br /> j. <br /> ` <br /> H.Handling'Codes for Wastes Listed Above <br /> 'G. d <br /> �;. Adfiarral.Pi3scz+ipwtlofor Ml terfats!a'isied Above <br /> Prot., <br /> IMMM <br /> tib <br /> ` 15.�p 41.Handing Instructions acrd Add#t raal.infarmatton <br /> k 01 <br /> AVAW ' <br /> Amu AV Aw JEW <br /> AFAW..-M <br /> 16.? ENERhTOR'9 CERTIFICATiOIVr I hr r�by.certify that the o4nter�t q►f thie.shlprnan 'e fully and acouratoly described and..are'in all.respects <br /> iri ptpper c x didoh.f or'hansport.Tti�r:m�iternals+descr beti�of1'ti�is rnanNest erre not subj t�y federal,Hazardous.waste r�egalations. <br /> Date <br /> Priiited/Typed Nanta $igrtawre.. <br /> Month ray Year <br /> `. 17.'Trahspoder l Acknowledgement of.Receipt of NtateriaJs Date <br /> R: <br /> A. 'yPed`N Si�natur.+e -�':"'`'` Marrtfi Ltey Ybar <br /> Ilk <br /> 1 c' <br /> t$.,Ttins iorter,Z Ac nowlei meat of Rec�eipt'of Matgri is Date <br /> Af <br /> Priittedj'ryped Name Signatui Month Day Year <br /> ic,biscrepanoy':Indic$tion Space <br /> h <br /> ' 26.Fhdtity.C3wrner or(�p.erstor; erErficxxifio :oi receipi.ot the waste rrtatetials:coYered.by thls m�arilfe ;except as noted iri:item 19. <br /> Prlrit, Typed t+lem� 9 Month Day year <br /> Si lure <br /> c. <br /> Wf/ �.r� ' <br /> 14 0'200 (� A- sm6 000)621y580r18p.•wwwJ%b@1['rAs1er.00m PMi1(1ED17NJ CfClED1'AMER tlffn <br /> U$+1+SDYMM N+rc IN <br />