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i_ea a Utz) V !A "' 8on Page of 2 <br />i�fartifi <br />rjIea4R"arbgvkcatdmri Form 5 Printed Cate :Oct 11. 2010 <br />ertlf•ICat qII- Applies to <br />Manifest Line <br />ft mr <br />Pursuant to 40 CFR 288.i(aj, l hereby notify that this shipment contains waste restricted under 40 CFR �1. 2. 3. 4. <br />Part 288. <br />I I <br />-_-_-----._----_-_ <br />_. ________ ___________------ i <br />This waste is rwt restrieked as speatied in 40 CFR 268 Subpart 0. 16• 8• 7• 8• <br />19. 10. <br />1 <br />l <br />Waste analysis data, where a ilabfe is attad,4, . <br />Signature -�... Print <br />Name <br />Tithe Date <br />_. <br />