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all - <br /> t. ,,J�/ ti4 r� -rte`- _f <br /> !y x ,' l � 1I tel' r ��.# �oc�p�'J�p r, �' {Ffo°rm Apprb'ved AMB Na.20.50.0039 <br /> l ','Beast pont or (Form designed for use onellte�(12-pitch)rypewtter.) <br /> 1.Generator ID Number s 2.Page 10l 3.Emergency Response Phone ' 1.ManMeat Tracking Nurnber h <br /> UNIFORM RDOUS , ��yay,S30d4C 0'0 4 8 2`2 513 JJ K- - <br /> =a WASTE MANIFESTS CPk y��• <br /> S.Generemr"shame and 'ling Ad Generators Sije (t dMe,ard maArg adAess) tl <br /> MC.A1elIu5 �Icvdc $ NaFe Mc1ae1 vs Fav <br /> 3/00�NrAA1Ati��'ty� t 3fo0 N. (id(ynA+ Cl t��2�S " !; <br /> GeneneemttoorssPPhaieJ'( C�1�^A�7�1`4�DZ 10 �v"3 <br /> EPA ID Number <br /> 8.Tm spone,I Company Name U.S. <br /> cebtY0lyW�NU�1-or�r�e1� \ Seo-�tces crA% <br /> e =j-714t? <br /> 7.Transport 2 Company Nam U.S.EPA ID Number <br /> 21ST CTITU(L CNVIICU AI MEISTA MANAGEMP'NT OF PIC ODA LL(- ARC. lb401Z <br /> 8.Desi nateA Faci Name dSteAddress U.S.EPAIDNu tier <br /> T ew-,,.T <br /> NV �kO S�iS33� <br /> �S F t .T <br /> �$ ��aa <br /> Ft 117 n!V `6g40g� <br /> FadRys Phone: �J�- 75 •7(0C) <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Ha and Crass,ID Number, 10.CanWnem 11.dotal 12.Unit 17.Waste Codes <br /> 9a. Quantity 'Mivd. <br /> HM �Packing Group(tarty)) No. Type <br /> 'wa5�e A�coso s FI a•,rA.bte e4c N 33 OEnI <br /> �exCeAtrS I t 0-&? ci�1 )2• I�uN tisQP3"� �� I (J �,', .� <br /> ) <br /> w <br /> 2. <br /> 3 <br /> 4. .1 / <br /> 14.Special Handling W ons anIAd ibcml In n �. <br /> 3Big � po .-5 11$`12 <br /> E9-4,'' 1 A to <br /> 55Gw\ 1 A.2 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the conlenlsof this consignment are fully and accumtey described above by the proper shippngname,ardareclassified,packaged,, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national govemmenod regulations.t export sNpmmm arid I am the Primary <br /> Exporter,I arty that the contents of this consignment conform to the terms of the attached EPAAce mviedgmentof Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(t I am a large quantity generator)at(b)(itI am a small quantity generator)o We. <br /> f Signature Monti Day Year ;+ <br /> GenemtorslOterors PdntedRyped Name 2/tal 6 <br /> F 16.Fmornational Shipmems Ll Import to U.S. ❑Event ham U.S. Pon ma <br /> = Transporter signature(for exports only): Date leaving U.S.: <br /> Oc 17.Transporter AcknWAadgmsm of Receipt a[Materials <br /> 0 Tl r 1 ntedRypM•dam - m MoOb Day . Y ar . <br /> a <br /> z Transporter 2 Pnnttq <br /> ed/fypae Name Sgnawre Month Day Year <br /> } 18.Discrepancy .- <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue ❑Partial Rejector ❑Full Rejectan <br /> Mantes,Reference Number: <br /> 18b. anate Faolity for Gor a atw) U.S.EPA ID Number <br /> J � 1 <br /> U <br /> LL Faciflys Pham: <br /> O 18c.Signature ofAftemate Faclity(or Generator)' an Day Year <br /> 2 <br /> 9.Hazardaas Waste Report Management Method Code's(Le.,codes for hazardous waste oeabnent.'disposal,and recydmg systems) r <br /> H 3 4. <br /> 20.Designated Facility Owner or Operator.Cerfil of mosiptof hazardous malarial a covered by the mantes,except as ncled in Item 18a <br /> ignahue Month Day Year <br /> 1 Pkdedrtyped Nw O Q <br /> _l-Y)�� VY��QiY�� O2- <br /> EPA Form 8700-22(Rev.3`05) Previous editions are obsolete. DESIGNATED FAciQry TO GENERATOR STATE(IF REQUIRED) <br /> 02-05-0 9A10555.0171 D <br />