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�''a �p'avea vhaB Na .059--0039lEx041e4 0 30 911! JV J� ra1ju L ueoenmenl ct ridann oervicea <br /> P nrec ,, or teal& Farm deo aad Front of Pa Tdxio Somtences control Division <br /> rpnad for use on a+He(i2 DlfCh fypett'rfter) . r fsye 7 '~ h Baorsmertto C411010ML■ <br /> UNIFORM HAZARDOUSI <br /> Qsnerstor a US EPA ID No M.ndest 2 Page 1 <br /> WASTE MANIFEST �' 4 , Document No Information In the shaded area& <br /> r r <br /> rL HI (� of is not requited by Federal law <br /> 3 Generator a Name and 1#Aaflkq Address r - A. 310* p � <br /> >� r •.I a V'\L f7\Tl, ry f�,#b %NL It',It', r% r � <br /> r ._ <br /> .- ,� s, .� 1. f <br /> /r Bute o@uarners ID; <br /> a Generator a Phone R 4' + R r of I-1 <br /> 6 Tranaponsr 1 � � - , 'r•t� ' 1 _ •' <br /> ` Comparry Name E US EPA ID Number CState Tran "Iii r r IQ <br /> w 1 1 f l �..1 r ` r D nnspertera P}mrla <br /> n7 Tranaponer 2 Company Name US EPA ID Number <br /> E Statim Trrttepat@rr ID <br /> F TraeapoRwti Pitim i <br /> 9 Designated Faetkfy Name and She Atldreas1D US EPA ID Number (} State Fafattlgna ID, _ <br /> C1 1 1:c tJ I.11. >i ic1Fif.'fr.Y1 r .� % <br /> � 1„tl Cry 2 > <br /> fa n �) IK Frow Phone <br /> t t 'tit 1 f 5i1 r i r k Tr ` r fr r+ t I <br /> s <br /> c5V-,37 <br /> LL O It US DOT Descripllch Oncitrdktg Proper Shipping Nome Hazard Class and ID Number) t2 Containers 3 Total I� <br /> Ouantity Unit wools No <br /> No Type Wit Vol <br /> L 14 v t r1 f flfftt! . <br /> E e 1 <br /> _ N ,s n (1 , t ! r ' : \ • s / EPA!Dthw ! <br /> E b ` <br /> A ti 3taN-L4 <br /> 'r, <br /> m T <br /> N 0 EPA/Cow <br /> R c ` <br /> = d -t r o>N <br /> Btaf@ k+7 "r <br /> U <br /> EPAIGNW <br /> z r Additional Deadtplbna for me <br /> tarlais Listed Abow o <br /> +►. K Hioniti g C""liar fMW"LIN"Abse l �� <br /> iTLI.40 <br /> d. <br /> �} ,t <br /> (� <br /> C <br /> 75 Special Handling Instructions and Addition■finforinalion <br /> \,J L a T,- 1 Yi ( CIE TIV <br /> ` <br /> It. SI\ST tG1l�b� �f<t�17Ft �ai1 ,W. <br /> C ; LLtI '32 �1 - 7 <br /> GENERATOR 3 CERTIFICATION I hereby declare that the contents of this consignment ars fully and accurately deal <br /> xlbid above by paper Mipping name <br /> end ere classtfled packed marked and labeled and are in aM respects in proper Condition for transport by higMray aaCardkp Ip■ <br /> N national government regulations ! ppNeabh international and <br /> 1f f am a large quantity generator I certify that I have a program In place to reduce the volume and toxicity of waste generated Io the degree I haw detennmad <br /> to be economically practicable and that I have selected the practicable method of Ireotmem storage or disposal eurr*ntly available to ins&Milch rnrdo ar i the <br /> present and future threat to human health and the emrtronment OR If I am a small Quantity generator 1 have maw a <br /> V Generation and select the best waste monaQemert method that Is available to me and that I can atford good faith @Mort to minirtt$e fiy waste <br /> Z <br /> W Prin4od/Typed Name Signs re <br /> lNONth Day Year <br /> yy 17 Transporter 1 AQknowted emenl of Recelpl of Materials <br /> C <br /> A Printed/Typed Nam* <br /> N <br /> S Af' Signs lure , onfh Day Year <br /> I r <br /> /t <br /> O tO Transporter 2 Aeknow ledoernent of Receipt of Materials ' <br /> E Printed/Typed Name Signature Afoefh <br /> Day Year <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> F <br /> 20 Fe iiity Owner or Operator Centication of receipt of hazardous materials covered by Ms manlfaat except as noted in kam 1g <br /> Print d Typed Name at a <br /> I � AIOrMh Day year <br /> 6W L <br /> t e022 A ,r Do Not Write Belo�Az e <br /> '100-22Re89)1"'1'00092 ad4kons are obsolete <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />