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<br /> UNIFORM HA7ARDOUS 1 GasroWrID Number 2Pege fel 3.Emegency Rmponea Phone 4.Manifest Tmc!dng Number
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<br /> 5.Gonembfe Name and Mellbp Atlrem remfe bno msa It andowt manmlingaddress;
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<br /> U.S.EPA ID Number
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<br /> . rensporlar 2 Company Name U.S.EPA ID Number
<br /> 8.DaslIjmsted Facility Name and U.S.EPA ID Number
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<br /> 16. GENEMTOR'SIDFFERORSCERTIRCA110N;I hembydedere NNuw mMante of!hb condgnmom em Mly and accurately doscled¢bore by the proper shlppbg name,and ere closeted,packaged,
<br /> maned end Iaboledfplecatled,and ere In el impectslapmper omd*n fwhsnepmtscMing to appl-:mble Intemammil and national gwammemal rogu'.a5ons.Ilexport ehipmentand Ism Ne Primary
<br /> Exporter,I cD*Uwt the conlontsof this mnalgnmentcoMorm to the tam oflhe mtectlod EPAAckrowledgmemcf ConwL
<br /> I certlfy0atdie waste mWmlzadw stalemeathI Wed N 40 CFR 26227(¢)(6Ina huge quendlygenontor)or(b)(If 1 am a smal quentirygonaretor)Is he.
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<br /> 1 n weanditai"marms El Import to U.S. ❑Expon6om U.S. PodufemryleNb
<br /> Trareandleraf slum for emnorts only): Daulsa U.S.:
<br /> 17.Transporter Acknowletlgmentof Raelpt of Metede:s
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<br /> 18.Dlawspancy
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<br /> C4 A Manbmt Reference Number.
<br /> 10b,N oma¢ e' (a enembr U.S.EPA ID Nuomkw
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<br /> 18a Slgnamra ofNlemete Faulty(W Generator) Month Day Ywr
<br /> 19.Hazardous Wan Repod Management MedW Codm(La.,wdoa for KRESIO SMte heeUnae,d0poml,end reryoing"=a)
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<br /> 20.Deslgnsled Fa^Owner a 0 CeNAoallonof mcetpl of hazardous materiels cwsW by ma menHaet mceptas noted In An 18e
<br /> Pdnt Name $ Monza Day Your
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<br /> EPA Form 8700.22(Rev.3-05) P Io ed1dons She obsolete. SIGNATED FACILITY TO DESTIM&TION STATE(IF REQUIRED
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