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r <br />i <br />Please Print or type. <br />,., <br />iY <br />i.. <br />(lorm demgned for use on elite (72-pifcnl ryPawhfer.) <br />~? Y.~ <br /> <br />MANIFEST /BILL OF LADING 7. Generetor'a US EPA-ID No. a^' ~t <br />.:~:,: Document No. 2. Pega 1 <br />,_„a <br /> <br /> 3. Generators Name and Mailing Address 0- (: /~S/ M~..r <br />; A. State Manilesl Ddgrment NUnlber <br /> : <br />~ <br /> N4..n r.ar,.W ~I~?~ B.State GaleretpYa lD <br /> 4. Genemtpr's Phone ( i ~ ~ 1 ~ L/~- nu <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. Stele TmrtSportelalD <br /> IRVIN OIL, INC. - <br />~ <br /> 130d Perk Avenue, Canon City, CO 67272 - (719) 275-4075 C O D 9 8 Q 5 9 9 5 <br />1 8 D. Trerrpatda Plane <br /> 7. Transporter 2 Company Name ~ 6. US EPA ID Number ~ <br />~, <br />[r <br />. E State Trelnponela ID 'i <br /> , <br />~ <br />, ~ F. TreruporOefs Plana <br /> 9. Designated Facility Name end Sile Atldreas 10. US EPA ID Number G. Slate Fetilily'a ID <br />~ <br /> ~ <br />. <br /> H. Feciktys Phan <br />n. <br /> 11. Shipping NamelDeacripuon 12. Containers 13. 14. <br /> Total Unil <br /> ' No. ~ . Type '~ Ouantiry d <br /> a. S] <br /> <br />! <br />1 L ~~°~ <br />/ 3 l ~ ~' <br />E b <br />i <br />: <br />E ~ <br />A .. - <br /> ~'l. <br />T <br />O <br />R c <br /> d. <br />~. <br /> Adddionel``Dascription! for Materials Listed Above _ -/ Y y <br /> 'r~l~ <br />O <br />~'f (•C ~nf (P IP <br />Fn D <br />US.M Iln Id : <br /> 7 <br />~/ <br />~ <br />/ <br />C~~')r .,, ~i rC ,.1/Vr-n'~ ~o~fYC R'~ <br /> ,t 1 <br />.. <br /> <br /> 15. Speaal Handling Inatruttion9 and Addillonal IOlOrmatlOn , <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lolly antl accurately described abare by <br /> proper shipping name and era classilied. pecked, merketl. and labeled.'9nd era In ell respects in proper condition for trenaport by highway <br /> according to applicable International antl national government regulaliona. .Y:~ <br /> 111 em • large ouaniby generaor. I CMih 1Ml I new a program in plea t0 reduCa IK volume antl Ipekiy pl wa90 genersled Ip the tlpree I love delemmned IO Oe aconp~ <br /> preClitlble and trial t nave aebdetl me precl¢ablC melhdd OI Veetmenl, eloregl, or d9posel Nrtenay aveilaale t0 me rMitl~ mimmitef Ina preeenl end lulure mreat Io <br /> neellh and Ina Cnwranmenl: OP, d I am a small Quendiy generator. I nave maW a gootl leilh ellpn to m~n~m~le my wNM gMerman end lNecl the Clef waste meNi <br /> melhdd Ihet n areilable Ip me and Inal I Gn ellord <br /> PrintedfTy ed Name Signature /` ~ Month DaI <br /> p <br />T 17. Transposer 1 Acknowledgement pl Receipt o1 Materials .. <br />~ Prmt <br />etl/rYped~ <br />yName <br />/ Signature _ Month Dei <br />5 / <br />l <br />"/1 <br />C ~' l I <br /> r <br />.. ~ fie. <br />p <br />p 18. Transporter 2rACknowledgemanl pl Receept of Malerlala <br />~ <br />R <br />T PrintedJl etl Name <br />Yp Month Day, <br />Signature <br />E <br />R <br /> tg. Discrepancy Indication Space - <br />,_,~ <br />