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Please print or type. (Form tleslgne0 br use on elite (t 2~pitch) typewriter.) <br />Form Approved. III I II I II I II IIII III ~98 <br /> UNIFORM HAZARDOUS t. Generator's US EPA ID No. Manifest Document No. 2 page 1 Information in the shaded areas <br /> WASTE MANIFEST P0040 of 1 Is not required by Federal law. <br /> 3. Generators Name and Mailing Address • nz4 NY oa 6 a9 • A. Stets Manifest Document Number <br /> HoY 131 - 3 tnl. ^ Oak Cr.ak Co. <br /> Oak Crgk, CO 80467 B. State Generators ID <br /> 4. Generator's Phone 619-8744 <br /> 5. Transporter t Company Name 6. US EPA ID Number C. Slate Transporters ID <br /> Raliotnal =lttretric, Ine. FOf0980791321 D. Trenaponer'sPhone 812-469-3475 <br /> 7. Transponer 2 Company Name B. US EPA ID Number E. Stele Transporters ID <br /> F. Transporters Phone <br /> 9. Designated Facility Nama and Site Address 10. US EPA ID Number G. State Fecilitys ID <br /> t^tie^al il~elsia, ITC. <br /> 1lvY 169 b. Ge!lhnlll^, 31 67337 H. Facility's Phone <br /> 1CBD9809649l3 31i-2S1-i3Y0 <br /> 12. Conta iners 13. 14. I. <br /> 11. US DOT Description (Including Proper Shipping Name, Hezerd Class end ID Number) Total Unit Wesle No. <br />o No. T e Ouantil WWaI <br />E a r <br />T' <br />E 10/4.54 <br /> w^!. *olYcrlozleae^d slph^eYl^-oleM-a II1112315 uQ ~/ a 1i- ` ~ r <br />T b. <br />O <br />R <br /> C. <br /> d. <br /> J. Adtlrtional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> .. tzan^lortMr. lill.d vltl+ >SOO pP <br /> 15. Special Handling Instructions and Additional Information <br /> 8N AltaelrlQ ahNta <br /> 1t^!. !e w.o. ~GIS00460 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ere fully end accurately described <br /> above by proper shipping name and are classified, packed, marked, and labeled, and ere in all respects in proper condition for <br /> transport by highway according to applicable international and national governmental regulations. <br /> Date <br /> PrintedlTyped Name Signature Month Dey Yaer <br /> z. , ~ - - <br />T 17. Transporter t Acknowledgement of Receipt of Materials ~ ' Date <br />w rinted/Typed Nerve Signature ' Month Dey Yeer <br /> <br />P <br />0 <br />1 S. Transporter 2 Acknowledgement of Receipt of Materials Date <br />i Printed/Typed Name Signature Month Dey Yeer <br />E <br />a <br /> 19. Discrepancy Indication Space <br />F <br /> <br />C <br />I <br />~ <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials covered by this manifest except es noted In Item 19. <br />r Date <br />T Printed/7yped Name Signature Month Dey Year <br />Style Ft56 Labelmalter, Chicago, IL 80848 <br />EPA Farm 9700.22 (3-84) <br />r;e~tF!t/1TQFt DOPY <br />