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84 p 11 13 09:34a Ponella Truck' tit:U t--- I"YL---- U 2 -4680 p.2 <br /> Please nriri:I(Form deigned(Or Me On(3:110 ti UP 11 2-02 1642 Form Approped.Okla No.2050-0034 <br /> UNIFORM HAZARDOUS 3Ganem 10'An2 83ber cf 3.E ency Respnnse Ph(me rma6s-,TrinNumber 77FLE <br /> _ 1"1 <br /> WASTE ItALI�Yl� KIN P n <br /> S.r— es, a <br /> HIL <br /> US,EPA ID NunW <br /> 7.TraMww I CoritpanNam y J.5.c-FVUD Number <br /> 8.p s F a1 Name nIsdie, US.EPA ID Nurke- <br /> ii Vs <br /> P <br /> gb.U-.F'-00T Descripficit irtiumqPne Sh-'pping Name,Naar,4C*&&.!D Number, <br /> V.CarlAinors <br /> Total Z-Unit <br /> HW aM Park"Group of any)) TypeQW1111ty eAlIkI 3.Nesta CadeB <br /> IVY <br /> AD w4t W, <br /> LU <br /> 3. <br /> 4. <br /> -?4- <br /> GNERATUIRWOFf-EKOR'S GERTIFIC R are 1hisuvfbignmen(are(illy,and accu;dWycesahn ntem,by,,.eprasTnhIppiw3 nvie_ard <br /> mwk�J a,)d 3rd are in al reso-'Cts In pm-cw4hon fix transo&',a�wdimc I,,eppbcaNa 1-vcnnslicrnaram:nalimal govermnants7 ffeXpcit sl arod,I moK <br /> c morm to Ill.terms c 0 me-alW*d EPAAckriWle--grI13'110f COtSSe <br /> j cwtfy Inat ftwam,mranizaticm 3b7temei(idetifio T- CFP,N2,27(ai(KI am S!Bq4o qtrwlty generator)c-('J)ftt I am a,awl quantmj Qrales}is vue <br /> -j 16,Intarnamr-Al spprWits <br /> l7rnrrod[a <br /> Tiapsoar[sf k-rAf6 jfcr 9,Tcts ojjj�): Date 1xima U.S.: <br /> W 17.Traw-prW ACk-,0Wie,1gm:1,N of koe.rr,1 at WaLi-S IS <br /> Uj <br /> ONmz 1?dnta Hyped Name <br /> W 8RC <br /> Trarportar 2 FrInt-AfTged,%TV Zpalure mm, r)ay Taw <br /> tow <br /> 18:piscwaancr <br /> 18a.Dsmpanny Wwtion Sow>a Quarmy Q T Ypa Residue LD Partial Rektion E7 Ful Rc4e-vion <br /> IMarpfam <br /> Reierance Number.18h.A lenmwie Fadi:y(or CmW,) U.S.EPA 117 Ner0--i- <br /> w �vm Ahmato I-aclity fo-Genvotor; K."orlb Dy Year <br /> cotco 19.4awdom W.s-R Repart Nivagawnc Malmo Godes(.e..mlAs for hazardous wasle trestmen',afsposal,avd myclin systarna) <br /> 20.Des-Snated Facility D.-mer or Operator:ceffirkafion of recalpi or:-Azwtow; aterials Vrw-md)y It markest armicas mM In I"!IBa <br /> Prix WfflyFed Name 5ignauneMuni Coy )rwr <br /> EPA,For.-n B70)-22 ftm 3-057 Novious cdJow are omom. DESIGNATED FACILI TY TO DESTINATION STUE OF REQJIREY) <br /> ............... .................. <br />