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<br /> 1.Geaefalor fp Number r - 2,,Page f of 3.Emergepcjr Respansg hone 4.Man€fest Tracking Number'
<br /> UNIFORM HAZARDOUS �
<br /> WASTE MANIFEST Ct A L 0 019 4 3 0 7 1 :; )424��'=
<br /> 5.Generators Name and Mallin Address Generators Site Address(if differeni Ehan mailing address}
<br /> PEr 1100,
<br /> Generator's Phone: 202
<br /> $ CA q-5524? f
<br /> 6.Transpor(er1 Company Name' ::.:-:.,::::_.'-j.._-- ::".. U.S.EPA ID Number
<br /> *j-01.11)OIL ENVIPONMENTAL SEW
<br /> 7.Transporter 2 Company Name U.S.EPA 10 Number
<br /> 6.131nated Fadhity Name and Slle Address U.S.EPA ID Number
<br /> MAW
<br /> 2730 e'1,3114' 0
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<br /> 14.SFe ctaliHandlin9 Instructions and Additional Information
<br /> WAVING$ APMOPRIATE PVC ERN �. IT
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<br /> 15r Rt(VERATOR`8lOFFEAUR'9 CERTIFtCATIONs,€I herebydeclarethat the coni of Elr€s�onsignmehiare(ullyand acc,iraW j described above hyEhe proper,shippiripprtt ,aid`aye c assl�ied;pay3ca
<br /> ` mQrltd�andfaiiefedlplacardpd,arid ie:ifiallfiespeilslnpropeiconditlonfo[EranspiRaceord€ng to applicable-InlametionalandneUodal govaininenlal[egufalions_IterlpoliaflpmenEandt �fte`P�imary
<br /> ' :;l 1ciofler,I.ra ify that the oopl8nts o$1h .Eons.€ timent conform to pro terms,of IhQ pitacbed.EPA'P eknptir[adgmertl of
<br /> � ' . .�' id' GII d'€ : GFt3?'2821 7 filalnalai ir. uarl :eii iaior pt'b Idl.ain'asmall iranll, en§ialorisirus:-;.,�.:;, ;.y;';;^.,'s'�:-1. ',,,•h.: : -'�?'; ".i'L
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<br /> 9" n', I)re,.{fo"ro>iotlgonty}: ? p Date leavingU.s.:
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<br /> tl7,.TransportsfAcknuMdgriiofRecefptofMaterials„ ,,- 1`
<br /> Transporter tPdnted/TypedName S€gnature � Month Day Ycar
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<br /> 18a.D€screpanoy.tndfcagon.Space_ O Quantity OTypo OResldue- OPartiafRoleclion •OFOReJEclion - '
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<br /> Mar fest Reference Number:
<br /> f ah.Ailemate facility(or Generator} U,S.E=PA 1D Number
<br /> u- Facilily's Phone: f
<br /> o Month Day Year
<br /> 1Sc.Sfgnature.ofAtlernalo Facility(or Generator}
<br /> .19,liazaido`ps V}fd�1e R' v ane ent Hlelhod,Codes fs.;voles far hazardous waste UOatmenl,dlsposal�and recyding system's} ' s
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<br /> EPA Forrr i70fR22(Rev.3;05) previous editions ate obsolele.'
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