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Please print or type. (Form tlesignetl for use on 12-pitch) rypewrlter.) <br />Fomr App.ovetl OMB No 10500089 E+pues 9J0-o6 <br /> UNIFORM HAZARDOUS 21. Generators US EPA ID No. Manliest Document 22. Page Information in the shaded <br /> WASTE MANIFEST areas is not regwred by Federal <br /> (Continuation Sheet) 01693 3 law. <br /> 23. Generators Name ITEC Mineral Gold Hill Mill L. StateManilestDocumentNUmber <br /> 9145 Sunshine Canyon Drive <br /> Boulder, Colorado 80302 M. State Generators lD <br /> (303) 478-1898 9908 <br /> 24. Transporter Company Name 25. US EPA ID Number N. State 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 /> <br />26. US DOT Description (Inc/uding Proper Shipping Name, Hezerd Cless, end lO Number) 29. ontainers 30. <br />Total 31. <br />Unit R. <br />Waste NO. <br /> „M No. T e Ouantit WWoI <br /> a was a amma a iqui , nap <br /> 3, UN1993, PGIII. D001 (3~0~+) ~l/~ r <br />~ <br /> J <br />('L' <br /> b. X RQ, Waste Corrosive Liquid, Basic, )~` G OUTS110H <br /> Inorganic, NOS (sodium silicate), 6, Dm ~ 70 <br /> UN3266, PGII. D002 ~4302~ / 1-n~16.) <br /> c 0 Waste Linseed Oil, Non Regulated DM G OUTS2061 <br /> (.1.02.9 ). / QSS <br />c d. 0 Waste Copper Sulfate, Non Regulated DM G OUTS <br />N (..7.0 1 1.) / 2/d~/ <br />E /~i l/ <br /> <br />,N, e X RQ, Environmentally Hazardous Sunstance 60~ M C70 ~s ~ OUTS H <br />T Solid, NOS (lead), 9, UN3077, PGIII. <br /> <br /> t. N Waste Ion Exchange Resin, Non Regulated DM P OUTS <br /> .(.1.018 ). ~ /~SO <br />(• <br /> g X RQ, Waste Flammable Liquid, NOS (ethoxy DM G OUTS203H <br /> 2-propanol), 3, UN1993, PGIII. D001 ~/ /q~ <br />C/ <br /> <br /> n. <br /> i <br /> S. Ad itional Descp' ns for Metpri@I} ov@ ~ ~c 11 / <br />A) <br />~j(Y~(B)ir~fKl`/ C)~-'?-~a (D)~-T-s~k <br />~Q <br />c T. Handling Codes for Wastes Listed Above <br />(A) - (G) M141 <br /> - <br />~ <br /> y <br /> 32. Special Handling Instructions and Additional Information <br /> (A) ERG #128 (H) ERG #154 (C) ERG #N/A (D) ERG #N/A (E) ERG #171 <br /> (F) ERG #N/A (G)ERG #128 <br /> EMGY #713/674-2406 Eltex, Contact John Black. <br />t 33. Transporter Acknowledgement of Receipt of Materials Date <br />a Prlnted/Typed Name Signature Dorn Day Year <br />N <br />5 <br />P <br />0 <br />34. Transporter Acknowledgement of Receipt of Materials <br />Date <br />a <br />r <br />Printetl/Typed Name <br />Signature <br />Dorn Day Year <br />E <br />e <br />F <br />A 35. Discrepancy Indication Space <br />c <br />i <br />i <br />r <br />Style CF18-6 Labelmasler, An American Labeimark Co., Chicago, IL 60646 (000) 621-se0a <br />rwnmov u~.ximwu <br />WOpIlf/MM ,IMR <br />EPA Foim 6]00~11A IRBV 9881 Prenous ean~ons are oosoiete <br />ORIGINAL-RETURN TO GENERATOR <br />