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Please <br />for use <br />UNIFORM HAZARDOUS '. eeneraror ID Number <br />WASTE MANIFEST 2' a l+rift 01 R nep <br />S. Generator's Name and Mailing Address <br />4VIired Aer.mo aaOss str.Uk4atry <br />II Row 6189 <br />IIR°,S whits mrk k"d <br />It I*;, C) {.'nrdauax,, C:A 4f27!< <br />Facility's Phone: 31116 35,J ot3�fi <br />go. gb. U.S. DOT Descdptbn (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />1. <br />Ftp, t)M126'i, W2atxte! Paint r-e.I,at.rz#i r4jktmvi"It <br />31 11 MOM) <br />� z. 44��t{a N1Ftlnmsht y>` s�,:l Lein, r7tyani.c. <br />n..a.s., 4.1, 1'1. #Plestthyl 1r:tILy1. K+ei;C3nxr., <br />X [4. <br />tIPi,3%tx "i, ftgt,ea Corxr,)mi,ve l.icjutd, <br />Tl. {I> osphortekta,:)ltd, <br />.e).s., 9, 1l'l #C:hrtxrtl11�1 #tIO(V7) <br />0 <br />Applied At rnrxpatrar sttNrt. ok e <br />843? f:,(, A7rpoa[t, al,y <br />8t*Hf'rytt, C'A gS-()6 <br />10. Containers <br />11. Total <br />Quanti/ty <br />12. Unit <br />WLNOI,rqumbF <br />No. <br />Type <br />h <br />21 <br />F <br />10790 <br />107 <br />ID 1 I 4-1 If <br />R.*da .12N <br />Zi RIR}A ISNidt I`J3 YRIF ).722iag <br />3) "32:1 1`wR(a! I.S4 4) R6734 Ei I: t72 <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: Thereby declare that the contents of ihisconsignment are fully andacoumtelydes <br />marked and IabeleNplacarded, and are in all respects in proper condition for hansport according to applicable international and natio <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />I certify that the waste minimization statement idenfified in 40 CFR 262.27(a) (H I am a large quantity, generator) or (b) (iFl am a small <br />Generator's/OReror's Pdnled/Typed Name SignaNre <br />LJ Import to U.S. U ExportJromS48� Port of er(ry/ex <br />Transporter signature (for exports only): <br />Date lea 'ng <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Pdnted7Typed Name <br />S _ <br />} 18. Discrepancy <br />18a. Discrepancy Indication Space <br />❑ Quantity <br />Hazardous Waste <br />1 20 Designated Fa lity Owner <br />Printed/Typed Name <br />Method Codes <br />El Type <br />for hazardous waste heatment, <br />Certification of receipt of hazardous materials covered <br />are <br />Residue <br />as noted in Item 18a <br />❑ Partial Rejection <br />No. 2050-0039 <br />,GBF <br />13. Waste Codes <br />name, am are classified, package <br />A shipment and I am the Primary <br />❑ Full Refection <br />GENERATOR'S INITIAL COPY <br />