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`Please print or type. Form Approved.ONE No.20510- <br /> UNIFORM <br /> 1050UNIFORM HAZARDOUS 1.Geremlor IN Number2.Page t of 3.Emeryerwy Response Fame LManHM hazking Numbw <br /> WASTE MANIFEST C"Ij-%VySME 1 021989119 JJK <br /> S Gerera er'a Name and Melln,Merge Generators Site Mean(if Moment Nan mewling m1dwg) <br /> Iti COSTA i SONS <br /> /" 131410 N WEST LN <br /> (?o9)Slo• SISa LOOT,GA 367, <br /> Garerebrafards. '1 <br /> 6.Tormenter t Company Norse U S.EPAID Number <br /> RAMUS ENWk~MTAL Si GAOO"O7,»i, <br /> 7.Transpader2Company Name US.EPA IO Number <br /> B.Designated FadliN Name and Site Mtlressgii"ES TECHNICAL SO iTili LLQ . U.S.EPA IO Num <br /> �.-4p1EE'i 17a( uY57 j-Ir✓>f iy,c'C � <br /> -. ...,...Az-S4,C4. 1/soy GA�Dooe3o19o3 <br /> Fandily§Shore- �F.'L�3J�� Sfl'} <br /> ga gb.US.00T Descdh6on gnirming Proper Shipping Name,Hack Class,IN Numbers, 10'(deta save 11.Total 12 Unt 13,Waste Codes <br /> HM andPang Group(dany)) No. Type Qmni ai <br /> CC 1' iP G 351 <br /> of <br /> I <br />' w I <br /> i I <br /> 3 <br /> I <br /> 4. <br /> 14.Special Handling lnslmcAoos aMAddXgnal Information <br /> m EfCdAI <br /> '.:Li T!1 OF IFNNEO AND USE A Vli fiD PPE <br /> :.O14TIR-i FANIOS FM RONMENVL 9Ep lib <br /> 15. GENERATOR'SrOFFEROR'S CERTIFICATION:I he"dxlara Nat Me contents of this consignment era bully erM eccwai casmhed abeve by urs header shipping name,add are Cesabed,pagedi <br /> merked are IabekNpk®ked,aro are in all meters in proper ceresson for manspod modest M li'lleagir,intemetionelarMnelknnlgovemmentel mgute0ons.X eapwt whinne ing!l em the Primary <br /> Eggplant I dean that the contents of this caregnmenl conform In Me terms of Me akached EPAAckiwvAebgmant of Gonumt. <br /> I oettgy that the waste nrthwestbn assessment Mani in 40 CFR 36217(al ldlamalmg.guenNy genwe$ra.nieftefY92 small guenXNg rwi is <br /> Gerlerabuf mfs PrktedRypM Name9jgn�plre Day Year <br /> ia.lnkmeliorel GM1gmenb ❑ImpatbuU S. ❑ExpwlM1wnU S. PMderlAylekX: <br /> F- <br /> M TmnspwtervgraburelburercporteonN): Date and,U.S.: <br /> W P.TranspederAdmeashetlgment of Receipt N Mwerek <br /> Transporter 1 PdnWVyhW Name 8grawrre J ii Year <br /> R 01,4 <br /> Thenewer 2 Pr'oblayged Name Sg1Mbure Mont Oey Yew <br /> 1 18.0 xrepency <br /> 18a.0isrxepanrylntllnaAonSpace ❑ through, ❑Type ❑Residue El Part RepcXon ❑Ful Rebotlul <br /> MaNks1 Reference Number <br /> 18be.AAemate Faolll,ler Generete) U.S.EPA 10 Number <br /> Cr <br /> Cr <br /> FaaNys Prone'. <br /> Q2 Vid,Signature ofAltent Feeley for Generate) Month 0, Year <br /> 2 <br /> N19,Hazardous Waste Report ManzgelreMMeNod Codes(i.e.mtlasfor lwmkonsweste treatment,tlispoaM,and recycling systema) <br /> 1. 2. <br /> Me Overnight FxI11ty Owren or Oderate',Ce Mengton of recap)N haeari melerels wmretl by the mnnXetion tsa noted mItem 10a <br /> 1 P.,Wy,d Name Soared, Monty Day Year <br /> EPA Form 870022(Rev.12-77) Previous reforms are obsolete. GENERATOR'S INITIAL COPY <br />