|
Hazardous Waste Division e•.. . ;., '
<br /> Box 8 :Litt[ twk, 72219 8913
<br /> a°
<br /> Telephone �Oi)
<br /> Y p•- .
<br /> " Please print or type. (Fomr designed dor use'on'ellte(12 plfelr}typewrrtef)
<br /> id FormApprovetl 50-0039
<br /> UNIFORM HAZARPOUS t eneretor's US EPA ID No Manrfest g9- Ihformation in the shaded areas is not.
<br /> Document No
<br /> red by Federal law.
<br /> WASTEAANIEEST
<br /> r,..
<br /> 3.Generator's.Name'and Mailing Address «• •-
<br /> . 5�111Y E� M S•
<br /> a/ii •QBY 4- 7✓7��wyY6rr�Ai1Y .M•6•SMS7Y•r/ •i•1•A�. -� �' �. �$l h„#�,
<br /> al.11•rm1AV/• /M•�
<br /> � �d•
<br /> `rJ
<br /> 4.Generator's.Phone «�^=•��x �,
<br /> e 5.Transporter 1 Company •q s ,Rae,...n n' B.; tiS EPA ID Ntmtber
<br /> —'f .EmR6k•rsw�.•6'idcWx ..•.'<.1..4:;. .x' '.6
<br /> i•�lT,Y+0.B•tiVF'�P•IX p ,Gi &S A'}r f+tr_.X: _ �•n '
<br /> 7.Transporter 2 Company Name �8.
<br /> :�w w"tf$ ;i " .'a4* r i L�`6k -� _
<br /> -
<br /> .•
<br /> U.
<br /> Rmill
<br /> aii�_i+rl�K�lrPt/(�,�y>e�1,'�.�7r6iiv{ }�r�''jj``'��� .vy�y��' � ,„��1 • c ° V r� ,fir ?N.�"t.
<br /> Bri.Ni JI hJitr xF'wf•M t epw t�#P5'.� �1 7. ti+ S { a £- i q,
<br /> bwk
<br /> Nil
<br /> .14.11 VT
<br /> td:US 156T Description
<br /> -.. .r^ns".?"� .K s..firs•u+:� «•�,qa x .'F'i do t.. ..,,,d ,.�+
<br /> G a,
<br /> �1f a
<br /> 'E.Ai'.•••s�"^5 ^;a.., rE .-•&,:'`�c'sy � «"y%Y�&f .,�r.. da., �r
<br /> 77.
<br /> 1,71
<br /> • sw,• ,e••C .�. �'a i ` ,�� t k' r 'i r ay,. y+tp _.., .. '^i ..4 Yk a,
<br /> •„+,1_} 'W.^dx• YrAJ-f&£J ' 'P BO ^' +�.+a"y&`•jI:C•'�w+ l �.:',r
<br /> r
<br /> ............
<br /> 1
<br /> 15.SISeciat.�la„dung_ y ripsar Addiri--otIInformation « y
<br /> t � e f 438 r }-.rl/� a g _."»” ',gym, r o..r•' * t RECO`�p � ICE H ♦a 9t
<br /> �y y� + •gcA,iii+�1.KV(�R� �.�Yi w• iaa7
<br /> -.' r vC R1 _. mgr _ ,i, _
<br /> ,. ir�4r:�.� < ��f39; CN9B c3OB. 1611. ERS W.4.
<br /> 16
<br /> GENEti46TOR S EEWIFICAFION 111ereb)pdeclars tb th content�ot ihisconsigrurtent are fullx and•accurtttely de enbed vab�roper shipping name,and are classified,
<br /> pgcitaged;'.irtartced;and labeled/placandecl,and are in rag s ifxprtiper..e itiitaon fortrarrsporttiy%h4vay'accordin 4�'appi ii TntemationaFand national government
<br /> r8gutations and 74rkansae` lations ;
<br /> iftamalar a quantity s
<br /> g q ty'gerieraton,kcettff}fthtiLk�haye:apragTaminplace20redt�e:theatciluMarld-oxiprlyyfyvaSt@•9enQ t . to e.degreeI havedetemtirredto.beeconomically
<br /> piacticabfeaod� have selected the.practicable methoe'of freatmegt stdra %` posaf,currently available to me whico thtnimrzes the pFesent and future threat to human
<br /> -<health aricfthe'enin. merit;OR,If I a&-a.small gaadtIYgenetator I ftaire made it; fafth aff,ort to minimize my waste genai�tiort atid'select the t1B3t waste management
<br /> rnethoil'ttfat:Is;a ' fG.Me and that t Can afford. t z, r 1 s 1 ” t a" T
<br /> r -- :+..:rS:,..;.r�f., st ,.i Ss. ,x •� 4 .,.'s:. •� ;��w�1.�4H .i dd......
<br /> Printedrryped Na az re Month Da Year
<br /> . : . �y aim st
<br /> 404
<br /> R r�tspgrtect AckroiMedgementof prof Materjais i
<br /> A Prtnt#Wlyped Name s t Sign' ne Month Da Year
<br /> tUt
<br /> Pp pinspoil.fwtowledgernenli of Receipt of Materials ^"
<br /> T. Printed(Typed<Name Signa Month Day/ Year
<br /> R
<br /> 19.Discrepancy Indication Space -•
<br /> T 20.Facility Owner or Operator.Certification of receipt of hazardous materials covered by this manifest.�xcept as.notilltem
<br /> Y
<br /> P(MiTyped Name Signature _ Month Day Year
<br /> EPA Form 8700-22(Rev.9-88)Previous edltiob is obsolete. ( ;
<br /> SECOND:TRZS#ORYEW.dOPY=.r. .
<br />
|