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Please print or type. (Form tlesignetl for use on e~-pitch) rypewriler.) <br />• Form Approvatl OMB No 2060 0039 E,pvas 9J0-96 <br /> UNIFORM HAZARDOUS 21. Generators US EPA ID No. Manifest Document Na 22. Page Information in the shaded <br /> WASTE MANIFEST areas is not required by Federal <br /> (ContinuatlonSheet) 01693 2 law. <br /> 23. Generators Name ITEC Mineral / Gold Hill Mill L. State Manifest Document Number <br /> 9145 Sunshine Canyon Drive <br /> Boulder, Colorado 80302 M. Stale Generators lD <br /> (303) 478-1898 <br /> 24. Transporter Company Name 25. US EPA ID Number N. Stale Transporters ID <br /> O. Transporters Phone <br /> 26. Transporter Company Name 27. US EPA ID Number P. State Transporters ID <br /> O. Transporter's Phone <br /> 29. Containers 30. 3f. R. <br /> 28. US DO7 Description (Including Proper Shipping Neme, Nezerd Class, end ID Number) Total Unit Waste No. <br /> „N No. T e Ouantit WWOI <br /> a. aste La Pack, Non Regulated J1.003 DM G OUTS0031 <br /> (;~ Q28 } <br />doa <br />o <br /> b. 0 Waste Sodium Bromide, Non Regulated DM G OUTS3191 <br /> <br /> <br /> c X RQ, Waste Corrosive Solid, Hasic, DM P OUTS319H <br /> Inorganic, NOS (sodium silicate), 8, <br /> UN3262, PGII. D002 (~111U-Y / 1-f~g4) ~,~ L•• <br />E d. RQ, aste odiu Sulfi a (anh drous), D P OUTS 9H <br />N 4. UN13 5, P I. DO 1 <br />E •000• - -02~ 143~T• <br />R <br />A <br />e <br />0 <br />Waste Ore, Non Regulated <br />DM <br />P <br />OUTS2191 <br />T <br />a <br />(ral-7) <br />~/ <br />l~ <br />~ <br />a ~ <br /> f N Waste Pine Oil, Non Regulated DM G OUTS2061 <br /> w 7 5 ~/O <br /> / .L026 / ~a2p / l~aaza) <br />(lo C D_ <br /> g. X RQ, Waste Corrosive Solid, Basic, ~ P <br /> Inorganic, NOS (soda ash), 8, UN3262, V'~r <br /> <br />PGII . D002 (:3AUAa / 1:OL0.) //~~ <br />~ C~ <br /> n X RQ, Waste Sulfuric Acid, 8, UN1830, PGII DF G OUTS105H <br /> D002 (1-849'} I Dory <br />dd <br /> ~ X RQ, Waste Flammable Liquid, NOS (methyl DM G OUT5203H <br /> isobutyl carbinol), 3, UN1993, PGIII. A~~<J~ <br />/ <br /> D001 L01:5r) ! <br />O <br /> S. Adpltional Descri do s)or Mg~erlely~,I~jgd, ye <br />lC)~'y~( D) R~^uNQ~ <br />(A)Oj~-llGl~~(B)NQ'"f475 ) T H$ndlip Godes for Wastes Listed Above <br />~A1-l~) M141 <br /> ~ <br />~ <br />'/(F)gB-44gD (G)ar6-y4~~ (H) 9Sr-4L19.~ <br />sr <br /> (I)xry~l <br />"" <br />ll <br />oo <br /> structions and Additional Information <br />ia <br />l Handling In <br />32. Spe <br />c <br /> (A) ERG #N/A (B) ERG #N/A (C) ERG #154 (D) ERG #135 (E) ERG #N/A <br /> (F) ERG #N/A (G) ERG #154 (H) ERG #137 (I) ERG #128 <br /> EMGY #713.674.2406 Eltex, Contact John Black. <br />r 33. Transponer Acknowledgement of Receipf of Materials Date <br />~ Printed(fyped Name Signature onlh Day Year <br />N <br />S <br />P <br />0 <br />34. Transporter _ Acknowledgement of Receipf of Materials <br />Date <br />e <br />r <br />Printed/Typetl Name <br />Signature <br />onth Day Year <br />E <br />a <br />P <br />A 35. Discrepancy Indication Space <br />C <br />I <br />L <br />T <br />Y <br />Style CFtB-6 Labalmastar, An Amencan Laoalmark Co., Chicago, IL 60646 (600) 621-5606 <br />nsnmaiecwnwa <br />Wn,a,fwr ~~rINN . <br />EPA Form B]00-22A IRev 9801 Prenous eomons aie oosorele <br />ORIGINAL-RETURN TO GENERATOR <br />