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' Ei9�t685-:; <br /> AM$(,.0.11 or type. Form des' ned for use or elle 12• ;lch t (�� � L5 U�. � 292 <br /> f � ( a 7 tYPemilar., I <br /> UNIFORM HAZARDOUS t.Cien"Of ID NumberFrf rtr Approved.OMS No.2050.0339 <br /> WASTE MANIFEST CAL00039J_0 2' °r rt FEnx19--y Rcs- Pnone 4,ManlfestTrackin Number <br /> 5 iNan*and MAng (E77) s:77— �y' 00 a 3125 DAT <br /> Gow,wors Si!e Address(f dd4lertrt than s+taiiig aCdress} <br /> DIG LOTS SIORLS DIG LOIS g4p <br /> 309 FRILLIF RD MTI: BEIM FERAL <br /> rUL1119@US 19c i321H 2591 !E. f 7 BLVD. <br /> GenealorsFhcne: (511)21E-I6iI 1HRCY CO 453537b <br /> 6-Transporter i CampanyName <br /> S1'1 R CYCLE SM-CIAL7Y WASTC SOLUTIONS INC U-S.EPA3GNrn{y� <br /> 7.Transporter 7 Company Na rne I ;M0110024 <br /> U.S.EFA ID N;,m9er <br /> 8 Designated f ciNy Name acd Site ess <br /> 21ST CENTURY LRVI U.S.EPA in Nurber <br /> Rat��ITAL nA�ll)sEr�llr of IIEYRDN, tLL <br /> 2095 Revlands Imre EaSt <br /> FacRysPho;te, FE101LEY ))Y @4{4B 1175) 515-115@ htYD98Ei89 338 <br /> 5a. Dlb-U.S.DOTOescrpUat(indudatg Proper Shipping Name.Hazed Gass,ID N m ter, <br /> HM, and tracking Gfoup IilanyA 10.Containe5 Ft.Tota 12.U:if <br /> Na. Type Quantity WtJtol. 15 Waste Cess <br /> +�sTE �iI05(315 2.1 ItO1DQQT=I@Ilfl DF <br /> K � � 331 DAQ! <br /> a �. Mill li Dow <br /> x _ <br /> r <br /> LNOR H1N.B.S. <br /> - r <br /> 4- I)±II993 URSTE FLAM,ILF LIQUIDS, N.O.S. 1)1E105EIC, KE5EL) 3 FII <br /> K RG1DdElI-I9@) P <br /> td,Sli Haediing fAsh Will s and Add genal In maI-on <br /> u) @LA �nsaLs-o� ��G1Iz�t � ascLs ' - <br /> f(? >LILRALiQ-@3 - ERG(121? FLA11MILE LIW135 <br /> 15. GENERATOR-31OFFEROR'9 CERTIFICATION:I hera4 f decEara 1ha[Ifie Conten s of lhs cons gement ata iuly and a suratelr descrbed above Gy!ha proper sh'ppog rrame I Ind are doss W.packaged, <br /> rnafked and labels q/ r;arded,and are in all respects in pfoparoondion for lrensport accnMing to appacahje intematona!and national govurmrentat regu3ntions.I!export Ship tens and I am dse Primary <br /> ["OF,I W*that the caftlents of this crnslgnmenl caotorfn to site leans of Hie aladted EPAAdapwladgrrggl of Consanf. <br /> I wrlify that the waste hnbaalran slatement idequi m 40 CFR 262 27(a)(d f am a targe quanllty generator}a b f I am a small quaint <br /> era r' ors Printed7fyped Name (1) q Y 9emerala}ss true. <br /> G6 5��t��—. r,3ortft Day Year <br /> S. temalionel SNpments t� <br /> z ❑Import to U S. E.Pw"m U.S. 'art of entryle„d _..--- <br /> Tram poor sigrwlrrre(fa wc—o onty}: <br /> 17 Transporter Acknowledgment of ReWPI of Maleriais <br /> 'fianspater 1 PtintedlTyped aanc S gnatu u <br /> Day <br /> K i ranspo is f 2 P yperf Na .c Sprna <br /> ture — h2 <br /> Year <br /> Day <br /> Fs.Dsen r <br /> 18a.Dlserrpancy tndfeatian Space Cluantry ❑Type L]Resraue <br /> PaNal Rejeciii Fu!Re)eclion <br /> 11th.AHemate Facility{ar Cierierater} klerwios!Raiarenm Number <br /> .� U.S.LPA ID Number <br /> U <br /> Facig ys Photo: <br /> 18c Sigrraturo alApea ate FaaiBfy for Generaler) <br /> 1larh Day Year <br /> x <br /> 19.Ha�rdous Waste Report Management Meliwd Codes(i o,modes for hazardous waste boatmen!,disposal,and tbgdng systems) <br /> LU <br /> t <br /> ZO.Designated Fae11',ty Ownef er Operator.Cerifiuwen of reca.pt of hazoMms maleoals covered ay tha mamfes'excep!as hated c ItenI—18a <br /> rdnladrrypedNames Signaitte ldo1nth ay Year <br /> EPA Farre 9700 22(Rev,3-05) PreviiDus edit ons are obsolete DESIGNATED FACILITY TO DESTINATION S ATE(IF REOUIRED) <br />