|
Plctnsn (art 'or type. (Form des!, r>aQ for use on elRij ( f 2 :AJI) ryP n riper. ) Farre pprrrrud Up {3 No� 2054 L4�39
<br /> UNIFORM HAZARDOUS 1 �w�crat }+ ID lduml er — __ _
<br /> Pao r 1 of 3 rnvrgonryRn g n.a ii atu ¢. E1mlh st rrackin NNumtrrr
<br /> WASTE MANIFEST
<br /> 41
<br /> JJK
<br /> ITIt
<br /> S G nest 's Narnv xnd " Marr' —
<br /> _ 4i . '. ,. GSn�rJ"� : y�{eF,cBt,asHla�.W,ze,tdaft�rima, tu7 .rftc_� j
<br /> Ctx:neratot'a Ffiksser
<br /> IG 1kwu
<br /> JS EPA Ili Ndintw
<br /> FaC �tys Ptx jo—
<br /> 6a . 9b USS DOT D nu' n coif - rr _._.:_. _ _ ._. _ _
<br /> r l wr � pr ,� r .DhH�rr Iran r4t`a Ott r " _
<br /> _ 4
<br /> HN anJPt3ckatc, C+wp {4a',y)) tit Cutl.� a , +, ! L (o' a fl Gr
<br /> ;g V:a Ccs
<br /> f
<br /> }
<br /> .� 2 . _.'...._.........—..--».�.........,—...e._-w..._ ........�.....�._..�..---....e._. _._ �.n.«,.....�...._.._-....y...__. t ' - k lye � i1 � � r
<br /> f
<br /> isr , Sw � wn96UL {9119
<br /> 1 4
<br /> IT
<br /> 1%
<br /> r �ENE4 -
<br /> _
<br /> 15. Cai�o df 4R SfflFFEROdo 1 CERTIFIt.AT10rd I hats fry d z ,u , it+.0 110 ca tr, r �d tra cans"0 er r 1 u fuFy a is cz ,+hky d y� w, six ev b} Lief ;opt 41-vott� nom, aw trrt dasatttoof p " J,
<br /> rruakc�l vrxf t ' 'let tho w 1, al rd f UT wt ry is c ulu r' wL-k at rut r a r d+ ccuuro ad &y { Vvih ter' � J -¢ n ,,d . ^ rr. s ` n _'- . x . 19 a r�rt t4 � w ; �.0 t •n Fns ^
<br /> 6zprxlar 1 cvtt,fy that Iha cor�aartj of U•13 arnsa�a,vroo,tt crntenn to L ,a Lftita ct N3 act kJ'l�Ac�ar�raotprr�� ci Crx air,. v
<br /> I certify 0lot IN waatu riynxnizoowi slat, meat Ide16114d In 40 CFIt6 + '?7(V) td I am a Iup y.rfrUt °atrt) a (D) ( i I rrn a asr a r;uzn6ry gc,aril<YirJ uz;�
<br /> m.�.. _
<br /> <' r
<br /> ti e
<br /> {
<br /> 1+3 intern r ra�� taxr�nt'; . : _. .._
<br /> �. Lj Irnwll to U. S, t_� r r{.�,1 here U 5 hwt tr; rs,trr, uar:
<br /> Tr t u c,ir+ su rNluta (fcv w ro:t oraAT
<br /> --••- .^- �-'--- _..__,r. __ ...m,... -W......�,....n.,. UaW 4Vaa ej U. S.
<br /> � 17. Tri'��rturAcmirw�-r�rluditccstlrlcdl.4cssrrlx � _- --�-�-�--- --
<br /> • }«� f t�' r f t t + na Dip Yo
<br /> TAT
<br /> Zz
<br /> t
<br /> rt,
<br /> Iv?Liiml Day 'ICS'
<br /> 1Rtvcun iFu R ea r
<br /> Rofow(w) wrr -h
<br /> 1— 1db kfofnato Famiy (or Gr;e�ll1s1j
<br /> C.1
<br /> FncAity e Phc 1u:
<br /> LU 18c. St"utn e! tVmr Asn Ft;;.@6ty (o( t�anilVasn) _.�---
<br /> C i"tn Day 6w
<br /> (9
<br /> 19. Hazauk,us Waxfo Rtitw11 f IsnaOunuml i thncl C : t o{ cx{ns fo , d a,rt a tresy Tse
<br /> syst i15)
<br /> lu
<br /> 1e" t". FQiad Facility pwner or Opar llar , CertiY,calion of mct< rl W hazaa kuy mala is crjI by Ulu Olt,, t, o, a
<br /> rint ped Nome " "
<br /> Sgna6are
<br /> r r for it Yr
<br /> EPA Form 870022 (Rev 3-05) Previous editns oro obsolm,
<br /> 1ib - + ; t; til C 'I , : t "I f l: PP IT01 "re f: P:Mzft� A 3�fl14 � '1',Si6= lIC � �P"4t 11 �t � ilV
<br />
|