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<br />ORIGINAL -NOS NEGOTIABLE ti G CJ
<br />- MA IFEST DOCUMENT"NUMBER
<br />' ~ ~ - ~ ~ ~~ ~ ~ ~ ~~ ~ SHIPPER NUMBER , :. ; .
<br />' NAME OF CARRIER ~ (SCAC) ~' ~ CARRIER NUMBER .-.
<br />IDENTIFICATION ~ _ .-..-•«'._,,:;•,:.,, :;,--'-'.•.
<br /> 13 DIOIT EPA ID/ COMPANY NAME,MAILIND ADDRESa,ANDTEIEPNONE NUMBEII •' ~ DATE aHIPPED
<br />OR REDEIV D
<br />OENERATON
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<br />_ ... t.... .. WASTE INFORMATION .. : w:: .:-:":"i,•.J~..:. }.Z_:.;
<br />NO. OF UNRB 1 EPA
<br />CONTAINER ~ NAT'
<br />Y/ABTE
<br />TYPE ID 1 - DESCRIPTION AND CIABSIFICATON
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<br />IeanlBlcatlon NumOer qr 172101, Iri70t, 17710.7 UN I
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<br />SPECIAL O INSTRUCTIONS ~ ~. ~ _ -
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<br />G•»~~; ~:'. .. I r ~s. '~~ ~ ~' .~ ~~ fi;?+II~* ¢< ~~ -_ ~, PLACARDS TENDERED
<br />fr •.:: .:, ..r.i v.~;~e',i:±.°' ... .- .r: ''.' C.4 _/611. S~I ~IJN r,T'.•c '°ILT.~'~~s!;'~?'t'`''`""' J~ .i I
<br />Dn -CDllxt on Dellwry' ahlpmente, the lelten 'C.OD' moat appear Delore conaipnee'a ~neme or a othsrwlee provided n Item 130, Seo.'1}'~• YB8_ ~~ ~ ~ ENO {~; -'
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<br />REMIT ~ -`-0~•IL'~.r. •'t :.."ty, yFS - ~. .. cG'.y r. / b 7.,!S`. ' ., r.e rL V~r pry'~..II,~'Y:..,. g,., jl `` C.O.D. Fes:'..
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<br />- COD' ~ Amt: • COLLECT ^ , .
<br />' Nor-rlr.Ilr ir•rarP.r.emwr. N,OOr•" •11 tna •hl manl more Nelr•an lrc • apr+rs.nrO'Tel tn. m,en~rn.AMr ~'bw •roo- e.u.rear TOTAL Y°~`-SFIT'i~~~ .Z'..~ ~ ~: r.•_
<br />.. nyu..e r.r.r s.errvrr.mrq nr ro+rew P pon M ,'. m~rm'~~'nwliw~wn'.m+b~:°. °'n!°!'!1"P'"n CHARGES: {a«'1hP,~`~i"' i
<br />ebd r•Ir N on rrnlerlr. a c•rrlar by r•lar, INa 1•r rpulra• itil IM aaw.r nr.nml:
<br />71r q~e s ecru .rw d mr rgrq r IrraV DIII of 1•alny aN•11 •1•te rNNNar II N Te• "'^r r"•" per .re eVUrr a •ii Mrw~~ rhlgA pro„rr a FREIGHT CNARGEB '•';;~ ' -=
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<br />' REGEIVED.•ul}c11oIM CIWlllplbn••nal•aN In NI•et Pn llB a•Ha m•I•ur•dtab °. ~T Ol, ula prOwNT Owr Nlw•rT ponbnd WarWN1OaMIrINbn Nratlro••en perry r•..F~~r~ ~
<br />BIII o1 L•aln/. Ih Poprh a.ola•e.mw b appBtll pooa w0•r, tlwpl tl nDltl (mnNrR• .. ~ rry Ilene mIB1•I.a In NI w arty ••W t%oPNT. IMI amt' wrb lO W pwiwnra Nwwlrrar ~~,i::.
<br />•b mrWRlan d oonlrol• N prA•paa urrsrlo+vrl. mN•0, mn•IprrN, •M euthra tl. Nvll es aualM ben ero DIIIN I•alnp l•Blr rla cwMllbro kl llr•Ilw•!nlnpNWBIa1Wr a;. '.,~..,-
<br />' Inalgl•e ap•w rlrkA Wem4 (IM rare vrlr ealn/ uner•looe INbrgNaa INN mnlrtl . Mr ene of aNlpnlwa. ' . ~• - , . ~ ..- .'' ~ : = < ~ 7r+"
<br />mtlnlrp •nI p•r•err ar mrpor•Ibn In po••~alwr W Iti pnlpcry ur,er IM oenlr•m) •pr•M 9rlppw NereN7 rwIIIIY IN•I lr I. 1•mlllr rIIN •Il llr dll of ltllnp trma W m10Nbrr M~S~ ~.{
<br />to m7 to NF u•W plo N e•Ilwry N tlN Oa1lNlbn, a wr IN roNa. OIN•rrlf• to aNhrr b ~ Ilr OO+nb/ eltlallbNlon W Irr the Irm• •ne fEr,eltlerlA w N•r•Oy aPtla b e7 Brand.,,,. i ,
<br />•rolNw nartlN an lM rwl•lo Yla belln•Ibn.Nr•mulWlry •w..etl lO •rr!'rarrlr of Nlw •Nlppw Ne •cc•DItl lp NlmtlllW NN tl•Ipr•. ..T„' ^:Jr ""t..'.!
<br />CERTIFICATION `' ~ =r: -•- ~= ; ' -
<br />TMa Is to ceAlly that the above~named meterlals are properly ThIS Is to certlly acceptance of the hazardous waste shlpmenL~~ '= ~h~=~~=t~:>~;~;.
<br />dassllled, described, packapeQ marked and labeled, and are In ~_., ~- • ..:~._ _ .~~ ' . „ ,- :•?r.,-'~'i~-%~,'+>•~ ~~I>"'~: ~•~`Z"~*1±Tr;r%r , .
<br />proper condition for transportation according to the applicable ~ ~ ~ ~ ' ~ ~ ~ -
<br />regulatlons of the Department of Transportation and the U.S. Fh TRANSPORTER F1 SIGNATURE A DATE TMNSPORTER I7 SIGNATURE - DATE (II reRUlrad) ,' ' :'
<br />vir~onmen~tal Protection Agenacy7.:~ , i~ ~ ~ ' ' This Is to certify acceptance oT the hazardous waste for treatment; ='.,:' -
<br />~+fNi..~~!' /6i'f~/~~?2Q.~.1 ,~~/ ~~r ~ storage or disposal ~ ..- ,t... r .~~'•. ~:7;z~''s`'~';:~.
<br />' GENERA R'S SIGNATURE ~ .• DATE •TSDF SIGNATURE r'~-, .y-'.,•.: i~ •, DATE'='.~, Ir~f ~,~
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