f) )

ITATE OF IH(X) lSLAMD AJm PIOYlDDICt PLAIITATICMS DUUTKENT OP DNIRONHDITAL MNACD1DJ

u DIVISION OP All AND ILAZAJDOUI KATIIllALI

~

AMnciMnU To lulu And JaautUone For laaudou Vaata Ge~tentioe Tun1portatton TnatMnt Storaae And Dhpoul lfhcUve 11 ~uly u

lffecttve 20 Spteber 1914

3 31 KnUt abell an the lhoda blaDCI Vnifo111 11aurdou Vasta KanUaat provided raquoy the DepntMnt or any other u t approvacl by thl United States tnvhonental Protection Aaancy for idantifyfna tut DOt lltt to the qubullntity copolitton type and the ortatft routtna and dttnattn of haurdoua valta fro the point of aanaratton includina dalianatad atoraaa dt11 to tM poblt of dhpoeel or treUMnt The lho6a tbnd UDtfo HaurdoWI Vasta Kan1ft alona vtth tnatructtona for coplattna it are 1n Appendix 11 of the rulebull ancl naulattona

502 ltonaa Any bulltarial dutanetad bullbull a hurdoue vta etond at the dta of aanaratioo for a period not to axued 90 daya ahdl H tarMd tn1p0rary atonabull and excluded froa atoraaa par-it requlrnts provided that bull~h vana ta ahippad off atta vi thin 90 days and 1a naaed ta accordance vttll thl provhioaa of 40 en 1262)4 and when appltcabla 40 en 26111l5 as are or bullbull shall ba aded Genanton atorina haurdo~ wasta for a period axcHdtaa 90 days shall obtata a storaae paratt ualaas the bull~t accUIIIulated ta ta than SS pllona

SOl C Tha aanarator IIUU COIIPlata the aenarator aacUon of a lhode bland Unifor- Baurdoua Waste Hanift or aaothar aanthat pdor to the ahtpbullat of tlw vane If the aenarator uaea other than a lhode laland Untfon RaurH~ Vaau Manifest he -t include all of the 1nforat10D required on thl Rhode JalaDd Manifest The aenarator uat uaa the deattnatton etaua antfaat if that state auppltaa the Nntfeat and nqutrea ita uaa If DOt the anantcr -at UM

the lho4a lalaod Kantfen

D After the transporter baa atpad the nuaat the aenentor ahall ra Copy 7 and ratura it to tha Dapartat Be aMll alao Copy 6 aM u 1t to tha state where the fadUty- b locaud

Copy I of the fo111 aMll be ntaiaed vith the aeneratorbull recorda The r tnina copiaa of the forw 1hall be turned over to the trans shyporter and shall atc011pany the weta throuah the routtna indicated by the aaoarator

P A aanarator _ instruct the traMportar to retura the waate if ha 1a unable to deliver it to the daatanaud facility( bull)

iJIogto~fiVmiddot~mentor shtppina vaataa via rail or vater WNst co~~ply vith the Iatona of 10 CFR 262 2l(c) or (d) as an or as aMndad-~

IIJill ~middottl f 601 J) The pendt vfll M aunt or renewed only for those hnadous vte

Whtcles vblch are lttH oa tM perbulllt appUceUoa aDI whicll lnspectlon Y Departnt penonnel (~bullbullf (1604 c Tha transporter Pall cCM~pleu tM transporterbull aactioa of the bullbulltfeat liampD thl Mntfaat arMS Jve Copiu 6 7 and I vfth thli IIMretor

ID tM tranaportar ahall tep the copletecl Mntfeat bullinbull Copiu 6 7

I with the haurcl~ wste vnttl recdWd try the condpu

1 The tranaporter vlll upon receipt of the haaadou vte ~ the conalanee raova Copy S for his recorda and tum over the rt of the bullntfaat to the conalanea

701 bull bull Pentits And Approvala bull All peraona vho ahall construct aubatantlally altar or operate a haudou wate tnatnt atoraabull or dhpoNl factltty or vho shall treat stora or dtspoM of baurdobull vaate -ampat flrat obtata u openttaa pandt or approval he the Director for aucb acttvtuaa eacapt thllt the follovtna ahllll oot require a peit or approval nor aball the followina be required to be ta copltance vltb lvle t of tbaH rulu and reavlatiDDII

o~ pound-~1r1 110 tlanihtta the fadlttr CNMr or operator uat DOt iccept oar wlte vithout

a c~leted lhoda bland Vntfo aaurdoua Vaate Maatfeat _t proceaa the Mnihtt accordiaa to auftdards equtvalnt to 40 en 26471 aa b or bullbull

~~~~11-r~~-t 1~tobull~or -aat n Copy 1 to the Departbullat Copy 2 to the atate vhare the vaata we paaratecl nd Copy l to the nentor Copy 4 1a retained fOI hta recorda

I Thaaa -bullbullbullta replace thOaa of ltke dadpattoo ftlecl oa 21 JUDI 1114 _

effactha on ll July 1914

1J [II ~tlaquoH- ~4 8

( ~~fbull gt~ tt -~~middot ~ ---~ bull ~middotmiddot ~ (ITI f-~-7(

Appendix 11

JNSJJiiUCTJONS JOJt COMJILITJNC THE aMODE JllAIID

JNPOMMrbull bS all instructiona before CC~~Pleting thb fon

Ub fon lnCCJIIIPleta incorrect or Uletible aanilesta are violations of the

lev and could allbject you to civil or cribulllnal Uebilitiea aa aAcitied io aho4e

leland IIUanloua Wute lleplatlau

thb aanifnt contaiae I copiu ALL COIIU IIUft U LZGJILamp lhe I copiu

-t be filed with Ua ewroprhte partr 8 ther an CC~~~~plated

COPY DllfIUIUfiCII ia U fol10111111

can 1 bull IIUTIIIATICII SDft - flailed lly ftllr1 ftia original atap vitb tbe abiat

f~ genention to Cllllpletion bJ the Tltll When the nifaat b ca~~plete4 tbe fIIIP

-t Nil tbb Cltf7 to the l tate bullen hb facility b located

ar 2bull GENEMTOil ITAft - SJad bJ ftllPbull When the ncr hu CCIIltlbullte4 hb

Mctioa of the aat~ift he u tbb copy ~ck to the ltata vhera the wasta

vaa generated

COP J a GEHEMTOR COMPLETED CCIP1 1 When the TSDP hu ccnpleted hb aection of

middot tha nifeat ha u thb copy back to tha Gerator of tha wasta who bullubullt

retdn it on-site for hb racoras

IIJill t~ l~r

f ( I I

0

I I I I

COPY 4 s ~middot Whera the nor has CQIIIIlet hia ~rtion of the Nnifen

- hi lleepe uibull copt for hh records

COPY Sa TMHSPOflID 11 When the transporter baa coplete4 his section of tiM

anut and tnnalera the wta to the TSDr he keeps this con for hia

recorcJa

NOJZa Jf a COHTINUINC TMNSPOinEa h used the venentor is napoftbull

vhich uat contain aitnaturaa when required

COPY DEITINATJOM nATE - Jtailad by Generatorbull When the Generator hu

CC~q~]atad hb Metion of the unUt and transfan hh wta to the traushy

porter he Mila thh con to ua ltate -n the dlllitneted heJUty CTIDIJ

h located

COPY 7a ~TOll ITAn bull Mai lad by the Generator 1 When the Genentor Nla

bull Cpleted bia Hction Of the aanUt and uanafan his wste to tho tunsptrt81

con Ia ~middot tiMII the Genuatw bu CC~~plated his HCtion of thl

anitaat and truafara hU vuta to Ute truaportel tle 11 thh CGPJ fN

hh nconb

NOna ALL I COIlEI HUft U IOAlLY LIGULE Jt- la GDIIRATOU Ul EPA JD 113 bull MNUZST DOCUMEIIT 1laquo) bull Entu the U l

DA tnentorbull 12 ditit iSntificatiOD nllllblr ben enter a UNIQUE 5 ditit

nUMr you tp to tbb anifeat V of aerially increadnt nlllllbera (

00001 00002 etc) 11 r~nded

Jtebull 21 IACZ 1 tl _ - Entar the total nEer of patbullbull used to COIIPlbullte thb

manifest ie the tint fom plus the nWIIber of Continuation Sbeetl if any

-

iJJilllt-1 bullrbullfbullbullbullbull f fl

I

IIJill ~middottl f 601 J) The pendt vfll M aunt or renewed only for those hnadous vte

Whtcles vblch are lttH oa tM perbulllt appUceUoa aDI whicll lnspectlon Y Departnt penonnel (~bullbullf (1604 c Tha transporter Pall cCM~pleu tM transporterbull aactioa of the bullbulltfeat liampD thl Mntfaat arMS Jve Copiu 6 7 and I vfth thli IIMretor

ID tM tranaportar ahall tep the copletecl Mntfeat bullinbull Copiu 6 7

I with the haurcl~ wste vnttl recdWd try the condpu

1 The tranaporter vlll upon receipt of the haaadou vte ~ the conalanee raova Copy S for his recorda and tum over the rt of the bullntfaat to the conalanea

701 bull bull Pentits And Approvala bull All peraona vho ahall construct aubatantlally altar or operate a haudou wate tnatnt atoraabull or dhpoNl factltty or vho shall treat stora or dtspoM of baurdobull vaate -ampat flrat obtata u openttaa pandt or approval he the Director for aucb acttvtuaa eacapt thllt the follovtna ahllll oot require a peit or approval nor aball the followina be required to be ta copltance vltb lvle t of tbaH rulu and reavlatiDDII

o~ pound-~1r1 110 tlanihtta the fadlttr CNMr or operator uat DOt iccept oar wlte vithout

a c~leted lhoda bland Vntfo aaurdoua Vaate Maatfeat _t proceaa the Mnihtt accordiaa to auftdards equtvalnt to 40 en 26471 aa b or bullbull

~~~~11-r~~-t 1~tobull~or -aat n Copy 1 to the Departbullat Copy 2 to the atate vhare the vaata we paaratecl nd Copy l to the nentor Copy 4 1a retained fOI hta recorda

I Thaaa -bullbullbullta replace thOaa of ltke dadpattoo ftlecl oa 21 JUDI 1114 _

effactha on ll July 1914

1J [II ~tlaquoH- ~4 8

( ~~fbull gt~ tt -~~middot ~ ---~ bull ~middotmiddot ~ (ITI f-~-7(

Appendix 11

JNSJJiiUCTJONS JOJt COMJILITJNC THE aMODE JllAIID

JNPOMMrbull bS all instructiona before CC~~Pleting thb fon

Ub fon lnCCJIIIPleta incorrect or Uletible aanilesta are violations of the

lev and could allbject you to civil or cribulllnal Uebilitiea aa aAcitied io aho4e

leland IIUanloua Wute lleplatlau

thb aanifnt contaiae I copiu ALL COIIU IIUft U LZGJILamp lhe I copiu

-t be filed with Ua ewroprhte partr 8 ther an CC~~~~plated

COPY DllfIUIUfiCII ia U fol10111111

can 1 bull IIUTIIIATICII SDft - flailed lly ftllr1 ftia original atap vitb tbe abiat

f~ genention to Cllllpletion bJ the Tltll When the nifaat b ca~~plete4 tbe fIIIP

-t Nil tbb Cltf7 to the l tate bullen hb facility b located

ar 2bull GENEMTOil ITAft - SJad bJ ftllPbull When the ncr hu CCIIltlbullte4 hb

Mctioa of the aat~ift he u tbb copy ~ck to the ltata vhera the wasta

vaa generated

COP J a GEHEMTOR COMPLETED CCIP1 1 When the TSDP hu ccnpleted hb aection of

middot tha nifeat ha u thb copy back to tha Gerator of tha wasta who bullubullt

retdn it on-site for hb racoras

IIJill t~ l~r

f ( I I

0

I I I I

COPY 4 s ~middot Whera the nor has CQIIIIlet hia ~rtion of the Nnifen

- hi lleepe uibull copt for hh records

COPY Sa TMHSPOflID 11 When the transporter baa coplete4 his section of tiM

anut and tnnalera the wta to the TSDr he keeps this con for hia

recorcJa

NOJZa Jf a COHTINUINC TMNSPOinEa h used the venentor is napoftbull

vhich uat contain aitnaturaa when required

COPY DEITINATJOM nATE - Jtailad by Generatorbull When the Generator hu

CC~q~]atad hb Metion of the unUt and transfan hh wta to the traushy

porter he Mila thh con to ua ltate -n the dlllitneted heJUty CTIDIJ

h located

COPY 7a ~TOll ITAn bull Mai lad by the Generator 1 When the Genentor Nla

bull Cpleted bia Hction Of the aanUt and uanafan his wste to tho tunsptrt81

con Ia ~middot tiMII the Genuatw bu CC~~plated his HCtion of thl

anitaat and truafara hU vuta to Ute truaportel tle 11 thh CGPJ fN

hh nconb

NOna ALL I COIlEI HUft U IOAlLY LIGULE Jt- la GDIIRATOU Ul EPA JD 113 bull MNUZST DOCUMEIIT 1laquo) bull Entu the U l

DA tnentorbull 12 ditit iSntificatiOD nllllblr ben enter a UNIQUE 5 ditit

nUMr you tp to tbb anifeat V of aerially increadnt nlllllbera (

00001 00002 etc) 11 r~nded

Jtebull 21 IACZ 1 tl _ - Entar the total nEer of patbullbull used to COIIPlbullte thb

manifest ie the tint fom plus the nWIIber of Continuation Sbeetl if any

-

iJJilllt-1 bullrbullfbullbullbullbull f fl

I

Appendix 11

JNSJJiiUCTJONS JOJt COMJILITJNC THE aMODE JllAIID

JNPOMMrbull bS all instructiona before CC~~Pleting thb fon

Ub fon lnCCJIIIPleta incorrect or Uletible aanilesta are violations of the

lev and could allbject you to civil or cribulllnal Uebilitiea aa aAcitied io aho4e

leland IIUanloua Wute lleplatlau

thb aanifnt contaiae I copiu ALL COIIU IIUft U LZGJILamp lhe I copiu

-t be filed with Ua ewroprhte partr 8 ther an CC~~~~plated

COPY DllfIUIUfiCII ia U fol10111111

can 1 bull IIUTIIIATICII SDft - flailed lly ftllr1 ftia original atap vitb tbe abiat

f~ genention to Cllllpletion bJ the Tltll When the nifaat b ca~~plete4 tbe fIIIP

-t Nil tbb Cltf7 to the l tate bullen hb facility b located

ar 2bull GENEMTOil ITAft - SJad bJ ftllPbull When the ncr hu CCIIltlbullte4 hb

Mctioa of the aat~ift he u tbb copy ~ck to the ltata vhera the wasta

vaa generated

COP J a GEHEMTOR COMPLETED CCIP1 1 When the TSDP hu ccnpleted hb aection of

middot tha nifeat ha u thb copy back to tha Gerator of tha wasta who bullubullt

retdn it on-site for hb racoras

IIJill t~ l~r

f ( I I

0

I I I I

COPY 4 s ~middot Whera the nor has CQIIIIlet hia ~rtion of the Nnifen

- hi lleepe uibull copt for hh records

COPY Sa TMHSPOflID 11 When the transporter baa coplete4 his section of tiM

anut and tnnalera the wta to the TSDr he keeps this con for hia

recorcJa

NOJZa Jf a COHTINUINC TMNSPOinEa h used the venentor is napoftbull

vhich uat contain aitnaturaa when required

COPY DEITINATJOM nATE - Jtailad by Generatorbull When the Generator hu

CC~q~]atad hb Metion of the unUt and transfan hh wta to the traushy

porter he Mila thh con to ua ltate -n the dlllitneted heJUty CTIDIJ

h located

COPY 7a ~TOll ITAn bull Mai lad by the Generator 1 When the Genentor Nla

bull Cpleted bia Hction Of the aanUt and uanafan his wste to tho tunsptrt81

con Ia ~middot tiMII the Genuatw bu CC~~plated his HCtion of thl

anitaat and truafara hU vuta to Ute truaportel tle 11 thh CGPJ fN

hh nconb

NOna ALL I COIlEI HUft U IOAlLY LIGULE Jt- la GDIIRATOU Ul EPA JD 113 bull MNUZST DOCUMEIIT 1laquo) bull Entu the U l

DA tnentorbull 12 ditit iSntificatiOD nllllblr ben enter a UNIQUE 5 ditit

nUMr you tp to tbb anifeat V of aerially increadnt nlllllbera (

00001 00002 etc) 11 r~nded

Jtebull 21 IACZ 1 tl _ - Entar the total nEer of patbullbull used to COIIPlbullte thb

manifest ie the tint fom plus the nWIIber of Continuation Sbeetl if any

-

iJJilllt-1 bullrbullfbullbullbullbull f fl

I

I I I I

COPY 4 s ~middot Whera the nor has CQIIIIlet hia ~rtion of the Nnifen

- hi lleepe uibull copt for hh records

COPY Sa TMHSPOflID 11 When the transporter baa coplete4 his section of tiM

anut and tnnalera the wta to the TSDr he keeps this con for hia

recorcJa

NOJZa Jf a COHTINUINC TMNSPOinEa h used the venentor is napoftbull

vhich uat contain aitnaturaa when required

COPY DEITINATJOM nATE - Jtailad by Generatorbull When the Generator hu

CC~q~]atad hb Metion of the unUt and transfan hh wta to the traushy

porter he Mila thh con to ua ltate -n the dlllitneted heJUty CTIDIJ

h located

COPY 7a ~TOll ITAn bull Mai lad by the Generator 1 When the Genentor Nla

bull Cpleted bia Hction Of the aanUt and uanafan his wste to tho tunsptrt81

con Ia ~middot tiMII the Genuatw bu CC~~plated his HCtion of thl

anitaat and truafara hU vuta to Ute truaportel tle 11 thh CGPJ fN

hh nconb

NOna ALL I COIlEI HUft U IOAlLY LIGULE Jt- la GDIIRATOU Ul EPA JD 113 bull MNUZST DOCUMEIIT 1laquo) bull Entu the U l

DA tnentorbull 12 ditit iSntificatiOD nllllblr ben enter a UNIQUE 5 ditit

nUMr you tp to tbb anifeat V of aerially increadnt nlllllbera (

00001 00002 etc) 11 r~nded

Jtebull 21 IACZ 1 tl _ - Entar the total nEer of patbullbull used to COIIPlbullte thb

manifest ie the tint fom plus the nWIIber of Continuation Sbeetl if any

-

iJJilllt-1 bullrbullfbullbullbullbull f fl

I

middot_

bull nebull Aa STATE -NJTEST DOCUHENI MUHHa - bullWilber preprint ed by J J eace~ on

r the Cot1Unuat1on Shee t s Enter th is n-ber in Itbullbull L On ea ch Continuatibull

lheet atta ched to or part of bull middot aanifest

Jtebull la GENEMIOAI NAME amp HAlLING ADDApound11 - Entu the (aa aott f i ed to

UA amp NiUnt a ddress of the Generator ftlb address should be the l ocation

that vUl Mftage the returned niteat foraa Cttovever a aanifest eopy -t

Jtbull 4 a GDfMJOAI PHONE NUHaEJ - rnur bull telephone nuber vith area code

bulln- I a ITATE CiDI m - the l tatll Generator m b the strHt addlbullbull bull of the

Generatorbull pick- bull loeation Jf the -n1n1 aMIesa amp the atrt addr ess

ua tM _ antllr bull_bull in tbb block

IMI of the first transporter tao vUl transport the waata

ttbull Ia 01 DA JD IC1MD - Inter the a s EPA 12 cUtit 1-ntifiQdon 1111111ber

of the tint transporter 1-ntified ia Itbull I

bullJua c IIAft tIWI ID - Inter tM lUte of ntiatntibull ud tM lteeue plate

_ of the vaau-carrytov portiOil of tM bicla baint uH to tiMe the

pick--

VALID U TIWUPOitTEA I JIEIUUT

an a uthoriaed agent o f the transporter can be raacbad

Jtbull 7bull TMNIPOitIER 2 COMPAHY MME - Jf awUcabla enter the copany

laa notified to EPA) of the 2nd transporter ~ will transport the vte Jf

ora than 2 transporterbull vUl be used usa a aantfast Continuation lbut and

list the tnnsportau in the order tbay will M transporting tba waste

Jtbull 11 Ul UA JD NUHMJ Jf awUcable enter the Pmiddotbullmiddot EPA u d i tit

lnUficettcan nllllber of the 2nd tnnsporter 1ft Jtbull 7

bull n Ea ITATE Mil JD Jf ewlicabla entu tM 2nd 1ranaportarbulla State of

r-htration and UcanH plata nlRbr for the vasta-car~lnt portion of tM

n ra fAANSPORTEAI PHONE Jf applicable antar the 2n4 1ranaportara

telephone nllllber vith ana code where an authoriaecl agent of tha transportal

can bt raacha4

IU Ia DrIJGNATC FACJIlY MMI I 11ft ADDREU - Ental the CD~PUY n (u

notified to EPAJ of the TSDF dvnatad to racev the wasta 111ta4 oa thle

aallinv addn

t- lOa Ul DA It truNIEa - Enter tte US OJ 12 dltit Uantlfication

bulln- Ga ftAft FACILITII m- Enter the MJLJNG AODREU of the 1CIP If U

lbtad 1D Ita I an4 tba bulliliot bullbull an the _ antu bull_bullbull

JU lla Ul DOT DrICAIPTJCII ~of tha follovint -at bt antanda 1M

cornet u s DOT (Dept of Transportation) for tba vuta u identified 1a

4t era Parts 171-177 (usually fom~d in Col~ 2 of Section 172101) tM

assivned DOl Jtaaud Claaa (U~Ually ia CDln J) the 4 41tit IMIa JD n~er

CColwe JA) ltbullmiddot9 middot bull Wasta Aeetona rl-abla Liquid Vlfl090) us DOT

raquina tha vord bullvaatabull Mfora or in tlla ahippift9 na- fol all heaardous

wasta

Itabull 121 CONTAINERS tNO TYPE) - Enter the nwnber of containan for each

wasta and the appropriate abbreviationbull fro fable 1 (belov) for the type of

container usad a

-

I I I I

1 1r11 I

(~dl flI

I

--

middot 1AILI J - CONTAINEa hPI

fONetal 41~ Mrre)l kbulltbull DfVOOSn dyen_ ttrrah kep _riberlloard or ptuc dr barrale bull

fPbullTanb porulfla n-carto lanlca (tank trucb) ~ant can

or-~ truck CYltyUndera ~Metal aobullbullbullmiddot cartOftl ca1 (inclu4iAt roll-offaJOfloWooden taona cartona caaaa crbullriber or phatic boxes

cartons casu IAbullIbulllq elotll 1phl each line

ltM U 1 Qriit (Vt Vol) Enter the APPropriate abbnvbtion ftc~~ Tabla 11

(below) for U wit of bullbullbullue UMd in detendnint the total bulluentity of

weate acdbed on bullch line Do 1101 uaa fnctiona

~Ilona (11qui4s OftlyJ

(4000 u Y~ic Jarda

h to en bullan Hl lubpute C 6 D Jf a ---ICM ftaft JliGUIAftD vute atlabull

then b DD DAITAft code atar bull-bull bull Do JtOt laaw blulr

~~ ADDITIAL 0pound1CRJPrJOMI POll MfDIALa JJITSD ampova - Enter deacdp- bullbull

Uoa (chellical ftAMI conatitaent percentevea ate) fol ftJ waste which haa a

Ul DOl ahiJIPlftl _ endint U aoa Jf you antuN a ftAft DEIIQfATED NU1I

CCU ia Itabull J prorlh deacdption ~r ftOta any applicable IPA Keurd Codes

Clpitabla (f) COrroslw (C) aactiw (A) EP 1Wric (E) Acute aurdou (H)

or rOxie (1)) Entu the apecitic travity Any bulld41UOM1 sirad vte

dcdption bullY be entered 11en

--

I

middotbullmiddot

Jubull U l SPECIAL NANDLl~ JfiULCTICtll bull AOCUJOMAL JUOiitATION - U thh

0- ace to indicate apodal trusporuuon treatMnt atorave or disposal or

IUJ of IAdirHJ inforMtion Jf an alternate faellity h ditnatH note it

tlore hr lftEMtTJcIAL J HJrrTr ttneraton IMdt ontor tho point of doparshy

ture hen (City amp lUte) Thh apaco My abo be used for bullbullrveney naponae

to~lophoM nU~~traquou and other infor-uion the venerator vhhoa to include ~ut

bull tt ampa HANDLING CODES - YSDF coaplotoa this section - bullooaivnatod

Facility Sectionbull (below)

4ato tho cortUietion (with date of tranafor to tranaporter) Jf a at1e

roprhto Mio Iron wtor 01 air) inaortod in tho apace below If another

rodo ia addition to tho bithway ode h used enter tho appropriate odll Ca

acceptiftl tho t~~Uta on ahalf of the let tzaNportor that penon bullbullt

acknoillledgo acceptance of tho Wato described oa tho aanUeat by aipihiJ -

onterint the date of rocipt

Jtbull 11bull TRMIPOitnll 2 ACJQIOifLIDGE - If applicable follow inatruetiou

DlllGMATm FACILlft ITIOII UCIICII

Jtbull amp1 MMDLIII CCOES - ltIDF COMPLETES) Enter tho ULTIMATE handlint bullthod -shy

Only thebullllflO)ed at ~ doaitnatd facility for each wute listed in Itbull 11

followint proceaa codea bullY be uaed1

I I I

illill 1

rrbull(Ittbullbullf I

I I I I

JrtbullAI~ UI - HOCUS CODES i~middott( I1

101 (Contlnen) 102 (TaM) lOS cvta ~Jle) IOC (lurfece amppow

701 (Tonk) 702 (lurfeee J ) OJ (Jneineretol) tot (othermiddotJpeclfr) rrbull Dlt (Injection well) DIO (Lendfill)

(Itmiddotmiddot IDlt lother- lpecifr)

105 (othermiddot acitr)

POIALt DIJ (ludace lllp0un6Nnt)

Jt lt a DJICUPAIICY IJIDICATJDM SPACE bull be authodaed reprentatlw of the

Sdpete4 fadUtrbull owner or operator -t note in thh apace any dtnifcant

bulliacrepancy lietween the weau Sacribt4 on the nt feat 1 the vaata actuallr

received at the facUtJ an njectbull4 terhle ahould be lhted here alonv

vita u in41cation of the bullhpoaition of the njecte4 Nterble Any awlica-

JU 20t FACUJft ONIID oa OIEMIOa CClfiPJCATJml - Print 01 type the _ of

the per-- ~ the veate on behalf of tM ClllllftU _ opentM of the

alpat ftat panoa t aclknoWledge acceptMoe of the wute

acrud bull the uifaat liJ dfllDt (bJ _ 1 anted of nceipt be

altan of U a~ ftDf ut ia41catu acct~ptutoa (except for 1t shy

eclf1ad 1A block 11) amp reeMnt vitb atat-tl oo thia Mftifnt

~==~~ta-=-uirmiddot ~te~~-~-r-tor atatea rbullger41nt the ccplation of acific nfonNtian lnc11Mied in lettenbull i_ A-lt You aay viah to contact lUte 119anctaa for -au inforatlon oa Uda aubjact

ALL I CWIU (JII 11111 POliN MUIf aamp IOlALLY UGIIU bull

--

jt-- DEPAJmiDIT or lNYUIOt~NTAl MAUCIJIDft Dlvbioa ot Air bullrwl Muadoua tsterhll

~ 15 Dnh Street ProvUenCe II 02tol 211- 27tl

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

--

middot 1AILI J - CONTAINEa hPI

fONetal 41~ Mrre)l kbulltbull DfVOOSn dyen_ ttrrah kep _riberlloard or ptuc dr barrale bull

fPbullTanb porulfla n-carto lanlca (tank trucb) ~ant can

or-~ truck CYltyUndera ~Metal aobullbullbullmiddot cartOftl ca1 (inclu4iAt roll-offaJOfloWooden taona cartona caaaa crbullriber or phatic boxes

cartons casu IAbullIbulllq elotll 1phl each line

ltM U 1 Qriit (Vt Vol) Enter the APPropriate abbnvbtion ftc~~ Tabla 11

(below) for U wit of bullbullbullue UMd in detendnint the total bulluentity of

weate acdbed on bullch line Do 1101 uaa fnctiona

~Ilona (11qui4s OftlyJ

(4000 u Y~ic Jarda

h to en bullan Hl lubpute C 6 D Jf a ---ICM ftaft JliGUIAftD vute atlabull

then b DD DAITAft code atar bull-bull bull Do JtOt laaw blulr

~~ ADDITIAL 0pound1CRJPrJOMI POll MfDIALa JJITSD ampova - Enter deacdp- bullbull

Uoa (chellical ftAMI conatitaent percentevea ate) fol ftJ waste which haa a

Ul DOl ahiJIPlftl _ endint U aoa Jf you antuN a ftAft DEIIQfATED NU1I

CCU ia Itabull J prorlh deacdption ~r ftOta any applicable IPA Keurd Codes

Clpitabla (f) COrroslw (C) aactiw (A) EP 1Wric (E) Acute aurdou (H)

or rOxie (1)) Entu the apecitic travity Any bulld41UOM1 sirad vte

dcdption bullY be entered 11en

--

I

middotbullmiddot

Jubull U l SPECIAL NANDLl~ JfiULCTICtll bull AOCUJOMAL JUOiitATION - U thh

0- ace to indicate apodal trusporuuon treatMnt atorave or disposal or

IUJ of IAdirHJ inforMtion Jf an alternate faellity h ditnatH note it

tlore hr lftEMtTJcIAL J HJrrTr ttneraton IMdt ontor tho point of doparshy

ture hen (City amp lUte) Thh apaco My abo be used for bullbullrveney naponae

to~lophoM nU~~traquou and other infor-uion the venerator vhhoa to include ~ut

bull tt ampa HANDLING CODES - YSDF coaplotoa this section - bullooaivnatod

Facility Sectionbull (below)

4ato tho cortUietion (with date of tranafor to tranaporter) Jf a at1e

roprhto Mio Iron wtor 01 air) inaortod in tho apace below If another

rodo ia addition to tho bithway ode h used enter tho appropriate odll Ca

acceptiftl tho t~~Uta on ahalf of the let tzaNportor that penon bullbullt

acknoillledgo acceptance of tho Wato described oa tho aanUeat by aipihiJ -

onterint the date of rocipt

Jtbull 11bull TRMIPOitnll 2 ACJQIOifLIDGE - If applicable follow inatruetiou

DlllGMATm FACILlft ITIOII UCIICII

Jtbull amp1 MMDLIII CCOES - ltIDF COMPLETES) Enter tho ULTIMATE handlint bullthod -shy

Only thebullllflO)ed at ~ doaitnatd facility for each wute listed in Itbull 11

followint proceaa codea bullY be uaed1

I I I

illill 1

rrbull(Ittbullbullf I

I I I I

JrtbullAI~ UI - HOCUS CODES i~middott( I1

101 (Contlnen) 102 (TaM) lOS cvta ~Jle) IOC (lurfece amppow

701 (Tonk) 702 (lurfeee J ) OJ (Jneineretol) tot (othermiddotJpeclfr) rrbull Dlt (Injection well) DIO (Lendfill)

(Itmiddotmiddot IDlt lother- lpecifr)

105 (othermiddot acitr)

POIALt DIJ (ludace lllp0un6Nnt)

Jt lt a DJICUPAIICY IJIDICATJDM SPACE bull be authodaed reprentatlw of the

Sdpete4 fadUtrbull owner or operator -t note in thh apace any dtnifcant

bulliacrepancy lietween the weau Sacribt4 on the nt feat 1 the vaata actuallr

received at the facUtJ an njectbull4 terhle ahould be lhted here alonv

vita u in41cation of the bullhpoaition of the njecte4 Nterble Any awlica-

JU 20t FACUJft ONIID oa OIEMIOa CClfiPJCATJml - Print 01 type the _ of

the per-- ~ the veate on behalf of tM ClllllftU _ opentM of the

alpat ftat panoa t aclknoWledge acceptMoe of the wute

acrud bull the uifaat liJ dfllDt (bJ _ 1 anted of nceipt be

altan of U a~ ftDf ut ia41catu acct~ptutoa (except for 1t shy

eclf1ad 1A block 11) amp reeMnt vitb atat-tl oo thia Mftifnt

~==~~ta-=-uirmiddot ~te~~-~-r-tor atatea rbullger41nt the ccplation of acific nfonNtian lnc11Mied in lettenbull i_ A-lt You aay viah to contact lUte 119anctaa for -au inforatlon oa Uda aubjact

ALL I CWIU (JII 11111 POliN MUIf aamp IOlALLY UGIIU bull

--

jt-- DEPAJmiDIT or lNYUIOt~NTAl MAUCIJIDft Dlvbioa ot Air bullrwl Muadoua tsterhll

~ 15 Dnh Street ProvUenCe II 02tol 211- 27tl

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

--

I

middotbullmiddot

Jubull U l SPECIAL NANDLl~ JfiULCTICtll bull AOCUJOMAL JUOiitATION - U thh

0- ace to indicate apodal trusporuuon treatMnt atorave or disposal or

IUJ of IAdirHJ inforMtion Jf an alternate faellity h ditnatH note it

tlore hr lftEMtTJcIAL J HJrrTr ttneraton IMdt ontor tho point of doparshy

ture hen (City amp lUte) Thh apaco My abo be used for bullbullrveney naponae

to~lophoM nU~~traquou and other infor-uion the venerator vhhoa to include ~ut

bull tt ampa HANDLING CODES - YSDF coaplotoa this section - bullooaivnatod

Facility Sectionbull (below)

4ato tho cortUietion (with date of tranafor to tranaporter) Jf a at1e

roprhto Mio Iron wtor 01 air) inaortod in tho apace below If another

rodo ia addition to tho bithway ode h used enter tho appropriate odll Ca

acceptiftl tho t~~Uta on ahalf of the let tzaNportor that penon bullbullt

acknoillledgo acceptance of tho Wato described oa tho aanUeat by aipihiJ -

onterint the date of rocipt

Jtbull 11bull TRMIPOitnll 2 ACJQIOifLIDGE - If applicable follow inatruetiou

DlllGMATm FACILlft ITIOII UCIICII

Jtbull amp1 MMDLIII CCOES - ltIDF COMPLETES) Enter tho ULTIMATE handlint bullthod -shy

Only thebullllflO)ed at ~ doaitnatd facility for each wute listed in Itbull 11

followint proceaa codea bullY be uaed1

I I I

illill 1

rrbull(Ittbullbullf I

I I I I

JrtbullAI~ UI - HOCUS CODES i~middott( I1

101 (Contlnen) 102 (TaM) lOS cvta ~Jle) IOC (lurfece amppow

701 (Tonk) 702 (lurfeee J ) OJ (Jneineretol) tot (othermiddotJpeclfr) rrbull Dlt (Injection well) DIO (Lendfill)

(Itmiddotmiddot IDlt lother- lpecifr)

105 (othermiddot acitr)

POIALt DIJ (ludace lllp0un6Nnt)

Jt lt a DJICUPAIICY IJIDICATJDM SPACE bull be authodaed reprentatlw of the

Sdpete4 fadUtrbull owner or operator -t note in thh apace any dtnifcant

bulliacrepancy lietween the weau Sacribt4 on the nt feat 1 the vaata actuallr

received at the facUtJ an njectbull4 terhle ahould be lhted here alonv

vita u in41cation of the bullhpoaition of the njecte4 Nterble Any awlica-

JU 20t FACUJft ONIID oa OIEMIOa CClfiPJCATJml - Print 01 type the _ of

the per-- ~ the veate on behalf of tM ClllllftU _ opentM of the

alpat ftat panoa t aclknoWledge acceptMoe of the wute

acrud bull the uifaat liJ dfllDt (bJ _ 1 anted of nceipt be

altan of U a~ ftDf ut ia41catu acct~ptutoa (except for 1t shy

eclf1ad 1A block 11) amp reeMnt vitb atat-tl oo thia Mftifnt

~==~~ta-=-uirmiddot ~te~~-~-r-tor atatea rbullger41nt the ccplation of acific nfonNtian lnc11Mied in lettenbull i_ A-lt You aay viah to contact lUte 119anctaa for -au inforatlon oa Uda aubjact

ALL I CWIU (JII 11111 POliN MUIf aamp IOlALLY UGIIU bull

--

jt-- DEPAJmiDIT or lNYUIOt~NTAl MAUCIJIDft Dlvbioa ot Air bullrwl Muadoua tsterhll

~ 15 Dnh Street ProvUenCe II 02tol 211- 27tl

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

I I I I

JrtbullAI~ UI - HOCUS CODES i~middott( I1

101 (Contlnen) 102 (TaM) lOS cvta ~Jle) IOC (lurfece amppow

701 (Tonk) 702 (lurfeee J ) OJ (Jneineretol) tot (othermiddotJpeclfr) rrbull Dlt (Injection well) DIO (Lendfill)

(Itmiddotmiddot IDlt lother- lpecifr)

105 (othermiddot acitr)

POIALt DIJ (ludace lllp0un6Nnt)

Jt lt a DJICUPAIICY IJIDICATJDM SPACE bull be authodaed reprentatlw of the

Sdpete4 fadUtrbull owner or operator -t note in thh apace any dtnifcant

bulliacrepancy lietween the weau Sacribt4 on the nt feat 1 the vaata actuallr

received at the facUtJ an njectbull4 terhle ahould be lhted here alonv

vita u in41cation of the bullhpoaition of the njecte4 Nterble Any awlica-

JU 20t FACUJft ONIID oa OIEMIOa CClfiPJCATJml - Print 01 type the _ of

the per-- ~ the veate on behalf of tM ClllllftU _ opentM of the

alpat ftat panoa t aclknoWledge acceptMoe of the wute

acrud bull the uifaat liJ dfllDt (bJ _ 1 anted of nceipt be

altan of U a~ ftDf ut ia41catu acct~ptutoa (except for 1t shy

eclf1ad 1A block 11) amp reeMnt vitb atat-tl oo thia Mftifnt

~==~~ta-=-uirmiddot ~te~~-~-r-tor atatea rbullger41nt the ccplation of acific nfonNtian lnc11Mied in lettenbull i_ A-lt You aay viah to contact lUte 119anctaa for -au inforatlon oa Uda aubjact

ALL I CWIU (JII 11111 POliN MUIf aamp IOlALLY UGIIU bull

--

jt-- DEPAJmiDIT or lNYUIOt~NTAl MAUCIJIDft Dlvbioa ot Air bullrwl Muadoua tsterhll

~ 15 Dnh Street ProvUenCe II 02tol 211- 27tl

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

jt-- DEPAJmiDIT or lNYUIOt~NTAl MAUCIJIDft Dlvbioa ot Air bullrwl Muadoua tsterhll

~ 15 Dnh Street ProvUenCe II 02tol 211- 27tl

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

JnGortwbullbullbulll__

M IIN~_

O To__I

bullbullbullbullbullbullbull P 11 f11

Jl __ C_ JJ US IPA ID H_ I e~~middot~~~~~~~~~~~~========~middot~middot~~middot~~G~N~~~~~~~N~I~bullmiddot~middot~~~~~middot~middot-~~~~~bull bull bull bull bull bull bull bull bull bull bull O rll

-H Ul DOTDHaieftfltw_IWillfN-HMMICMJLIMIDN_ Jt c shy

1~------------~--------------------~~~~~~~~--~-----shyir------------------------r~~~~~~--~

Jl----------r---o--t--t-------1

shy

-

COIY 1 DESTlN110~ STATpound - Hailbulld lly TSDF ~cJ

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238

middot

11M foreaotaa _ to the lulbullbull Alwl laaulatlonbull Por hampardoua v

r-- Generadoa 1Tan1portattoa Tnatat ltoraaa AM Dbpobullal after dM aotlca

artq are bera adoptd aDd fUU vith the lecretar of ltata thb

U7 of Auauat 1114 to Meo aflacttve twnty aftn fUtq 1a ac~r-ce

vttll the provbiou of the Cneral Law of lho4e Jdaad lt56 bullbull __ CUrn

42-35 epecUtull7 lecUou 42-lS-3(a) ud 42-lS-oCtbull) Chapter 42-17-3 apedlfully

Scttoa U-lll-2amp Chapter U-191 epedftcal17 23middot191-6(amp) enl the Publlc Law

of lho4t blend 1971 Chepter 229

AttQt A true CopJt lrrdronbullotal ltaMu loud

rector of avtroneatal Kna-nt

lotica amphn ODI J AUIUit 1914

hariaa held on 24 Aupat 1914

PUadz ______

I I I

IIiI r=t~ (~middotmiddot

I

1. barcode 565238
2. barcodetext SDMS Doc ID 565238