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Please print or type. - <br /> Fortn Approved.OMB No.2050-0039 � <br /> UNIFORM HAZARDOUS 1-� t ID Number 2.PeAelof 3.Emergancy ReeDonse PM1one 4,M1.1f,t Treckl.Number ��� <br /> WASTE MANIFEST 0 2 p•I } <br /> 5.Generebfs Name- ,,,Iq Add— 61.1 11 Site Address fIIdlHerenl IM1anmailing Wtltaaa) <br /> lit <br /> 113YM 1,I:ARRQL:1&4 AVL <br /> WUN,t.;A U63"1 <br /> �.�i cenemtpra Pn Y 1'dn33 <br /> 6.TransPoder 1 Cwnpany Nema U.S.EPA ID Number <br /> r -tdLRry,ary.vl l_♦_'l tarepft C111 11J(, r.AkDOOY72:RYt <br /> ].TanspoNer2Compeny Neme U_S.EPA ID Number <br /> R r,pF:p 11`;A{ <br /> Y 8.Desgllatetl Fadliy NOW and Sile Address U.S.EPAIDN—, <br /> 1_I1._.1 lb it-; r,2pff <br /> F T'S Phora'.P141-44-11'fl . <br /> ga_ 9b.U.S.DOT De P-pndWiN Pmcer Shipping Name,H—M Class,IDN.,W,,, 10.Containers 11.TOM, 12.Und 1J WmN Codas <br /> HM aW Pa NG=p(daW)) No. iYce Quantity WI.NoI. <br /> I <br /> !yrs'M4TP['Wa,t1AZaRFK0.1$S•I+-7R. .LIF1R,4.9.9 rFftRPITP..c iNL.. '. <br /> 2. <br /> CO s <br /> 3. <br /> 4. <br /> 14.Spatial H wlhg Irthvdbra,W ASdibonal Info fi. <br /> '�ltilrk it VN l'. L". I <br /> L-ntF r:=3LtJ:,,1_H—A't_rlLlt <br /> 1, GENERATOR'SrOFFEROR'SCERTIFICATION:IharebytleclareNai NeaNenk of Nis cendgnmentare Nlly and aauratelydeeoibetl above by ihepropersniDprg name,aN areclassified packaged. <br /> -* and IabeIWlMaraNetl,endarein all respects in praperrontlNonim transpwtap�ardirgbappliceble inlemaAonaland naAonal goaemmenNl reguladms.liexpodshipmenlaW am Ne Primary <br /> ExpMer,I ceNN Nat Ne conlenkol NismnsiAnrrent Wnienn to Nia��m�of Ne atladletl EPAAGnowlWgmenlof Consent <br /> I arUN Nat Ne waste minimiradon siabmanl itlanNad in 40 CFit 2822]lal(Mlemalagequantiry penerebr)or(b1lAlamesmall quanary geneatorl is bus. <br /> GerleratotsrORemis PnnNQRYped Name Sgnawre M71h Day Year <br /> i6.IraemaAmrel Shipments ❑ImPodb U.S. ❑Excel hom U.S. PMD(eaaylaut: <br /> Trz podersgnelure lbr expods my) Date having US.: - <br /> tY1].TrmrecederA.cknowlatlBmallol ReceiPlol MaMneb "'•w,`,'..�; <br /> T_ 1Pn YDad Na/me! SIf6p/eQ1% /„7q Monty Day ; <br /> iQ TranspoMr 2 Pnnied yPW Name SgneMre Monty DaY <br /> K <br /> t18.Dsa'eDa <br /> 18a.0isae�'wylMiwlan Space ❑OASWy ❑Type ❑Residue ❑P—i ReleDWn ❑Full Rejection <br /> ManileslReferan�Numba <br /> 18b.Allemab Faality(a Garwrebr) US.EPAID Number <br /> U <br /> LL FaaIINa PMre: Monty Day Year <br /> w 18c.Sigrabre ofAAertale fadllN lw Generabr <br /> 6 <br /> Z <br /> y19.Haaabous Weate Report Management MelhW Cadae li,e„codas for haurtloue waste heetmenl,disposal,and recycllnA systems) 4 <br /> O ' <br /> 26.Dedgnalede Ilty Owreror Operebc CeNfl............MM1arardas meWrlels covered by lbe maninelurecep es ntletl In lbm lBa N Da, ear <br /> 1 nntedRY <br /> EPA Form e]oP22(Rev.""I Previous adltlona are obsolete. GENERATOR'S INITIAL COPY <br />