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~~~ ~~~~~~~~~~~~~ ~~~ ~+l~' 5597 <br />Please Prin1{yr type. (loan deigned for use avl elite (12-pircn) 1Ypewrlfer.J ' 999 <br /> 1. Generatofs US EPA,ID~NO. ~ ~ ani es~ <br />Document o 2. Paget ECEIVE D <br /> MANIFEST/BILL OF LADING . <br />... of R <br /> 9. Generalpr's Nama~o Mayling Atld~re <br />1 ps, A. Stab Manilel~yumheL <br /> <br />M0. <br />1Q- <br />e.ss C rC <br />TlOn ~ <br />I lyy <br /> ~ <br />1 ~{ <br /> J <br />~aCkU0.~E'~1r0, <br />K <br />~~l(3 T(C11 ~r6a.p f e. slabGarerewrslD <br /> 4. Generetoi s Phone ( ~ 1 (- L <br /> 5. Transporter 1 Compeny Neme/Mailirp Addres9 6. US EPA ID Number <br />IRVIN OIL <br />INC C.Sbb Traruporbra lD <br /> , <br />. <br />1304 Park Avenue. Canon City. CO 87212 - (719) 275<076 C O D 9 8 2 5 9 9 5 1 6 <br />D. Tmnsporesfs Pnaro <br /> 7. Transporter 2 Compeny Name B. US EPA ID Number E. Stele TrarleporbfslD <br /> F. Tmrlsponefs Plnne <br /> 9 Designated Faciliry Name and See Address 10. US EPA ID Number G. Slate FacdiyalD <br /> IRVIN OIL, INC. <br /> 1610 L Slreel <br />Penrose, CO 87240 <br />H. Fetililys Ptlone <br /> C O D 9 8 2 5 9 9 5 1 6 <br /> 11. ShiPPing Name/Description{=Y.i+~.~1"yy-.iii `,VI~,y•.~'4y`p, r. yv."° <br />o.~~ <br />4' <br />R"~~ ~°l <br />:; . E' <br />a <br />`-1 <br />i r " <br />~ :.'2: Conlainefg <br />+f~ <br />r:"" r` <br />~ .::~*oWa4;'{j v, <br />Qtal <br />~ R'~f( ~~74. <br />Unn `:- <br />7 Y.:;; <br /> y,, <br />l <br />r <br />, <br />i <br />~ <br />. <br />2 <br />...4 L ..~\i.a.... Pl.fr'~IL. wt ~r i <br />- <br />!AND:.- Type!- , <br />', uIV16IY-::', WINOI . <br /> a <br /> pp <br />1 <br />/ ! ' <br />M ~~ 9 ~ ; t <br /> rp <br />r <br />G <br />E <br />N <br />E <br />j <br />R <br />~ K <br />T <br />0 C. <br />A <br /> tl. <br /> Additional Descriptions for Materials Listed Above <br /> ~ P <br />-+ ~ <br /> ~ <br /> I5. Special Hanoling Iniltue(+_ons and Additional Inlormalion <br /> -.y` M"r- <br /> 16 GENERATORS CERTIFICATION: I hereby declare that the contents oI Ihis consignment are luny and accurately described above by <br /> proper shipping name and are classified. packed. marked. and labeled, end ere in all respects in proper condition for transport Dy highway <br /> eccortling to applicable international and national government regulations. <br /> li I em a large goanitity penereior. I car Lty iNi I love a program in place lp reduce 1M volume aro io+City of wave generaieo ip me oe9rve i love oelrmine4 io ee economically <br /> praclicapb ano inai I nave aelecteo me pracncspie metno4 0l Irenmenl. sbrpe or depoal curreniiy available io me which minimites me present ano future invest to human <br /> neelin and the enrironmenl: OR. it I am a smell quanihly genaraior. I liars mees a pooo laiin ellon ip minrmrta my waste peneraton ano select ik Oast wears merupemanl <br /> memos inai if a.anahie to me ano :hat I un aflora <br /> s.6 <br /> <br />YP ~rY' w a <br />Primed/T ed"Narile`•;'F='~ ~ :'i'`v.:~~ ~ ~ ~`~r'~'~~ "rYV ~'+ ` M <br />I ~Ip ?e~~: v:x~.y~~~ ~ n•. 'a ;f,F; _ ~.MOnfh ~De ` Year <br />~Sy ' d rt t 5 ro. );~ '~ <br /> <br /> <br />T 17. Transporter 1 Acknowledgement of Receipt of Malaria is ~ <br />~ PrintedRyped ame <br />Signature ;~'~ Month Day Year <br />~~ <br />N i <br /> <br />p 16 Transporter 2 Acknowledgement of dept of starlets ~ <br />1 Printed/Typetl Nama Signature Monrn Dey Yeer <br />E <br />n <br /> t9 Discrepancy Indicaaon Space <br />F <br />A <br />c <br />i <br />a <br />I <br />r 20. Facility Owner or Operator Cerlil lcalion of receipt of materials covered by Ihis manliest eaceDl as noted in Item 19. <br />Y Prinled/Typed Nama Signature Monln Dey Year <br />