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Pieasx grin,or type,iFom designed for use an elite(12-ROah)typeewriter.! y ''j Form Approved.OME No,2G50-6039 <br /> UNIFORM HAZARDOUS Generatpr 1D Number 2.Page:of 3.Emercanry Response Phone A.Manifest Tracking Number <br /> WASTE MANIFEST J J <br /> 5.Generabry Name and Atadoy Address Genennor's Site Adr m(ird faent than maiing address) <br /> Gamin unrs Phone' !` <br /> 5.TranSaIXNr 1 Company Name drama.a U.S.EPA ID Number <br /> I T Tien!",.odBrl Cpmparq'N8m9 <br /> DEC0 8 U.S.EPA014i <br /> s.Design"RdFamily Nomeand Ste Addre55 ENVIRONMENTAL HEALTH U's."'i"Npmpr <br /> DEPARTV1ENT <br /> Fadr aFNtane: <br /> ya 9b.U.S.OOT Description Cmdudv'g Proper Shipping Noma,Hazard Class,ID Nul 10.Conta:nare f i.Total 12 Unit tg.Waste Cores <br /> HM and Pa0ing Group(d any)) Na Type Quantity N'uNPI. <br /> C <br /> O <br /> 2 Z. <br /> m <br /> t7 <br /> 3. <br /> a. <br /> tb,Samara Handling InslrucLcm zor Aimtcal Imormalm <br /> 15. GENERATOR'SiOFFEROR'S CERTIFICATION:thersby deJare mx:th norten0 cimis wrbignment ora luilyaM apamately destribeC above by the proper snippk+g name,atd are classfed pamaged. <br /> marked and lamledhilawrded,and as in all respects in Groper canall for tra port accoming to applicable ifflonwdonaland na'.ronal ammentai recutatipns.ltexport shromem and tam the Pnmary <br /> Exponlve I c ifr mat the contents of this consignment conform to me bums of the mul EPAAeKnowledgmbm of Convent. <br /> I certify that the waste m:nlmil statement itlentlfied in 40 CFR 262:27(a)(R I am a large quanay generated or(b)(11 am a small quantity genenal is due. <br /> GenamlervCRfemts-nnia'Typed Name Slgnturs Month Day Year <br /> J S6,tnlamaLanal Snipments i� <br /> p. ❑ImpoM1 at U's L1Eapan from U.S. Ferl atemrydezS <br /> g Fmnspaar signature(for ex,vts anryy: Cate Ieeving U.S.: <br /> Ranspcnar:.chrvxkevwl of'nemor of Materials <br /> C <br /> —1 i PnnlecTYPe Nama Signature Menm Day Year <br /> a <br /> �¢ Tran so*l..:'2 Frir:teclTyaaof Name Signature k4woh Gay Ynser <br /> it <br /> 16.Disprepancy � <br /> ( Ilia.Cevepac.lndiratton Spam JTs , <br /> Pra! ejQuan:ey yp ❑ Reectfon <br /> I i <br /> marionst Renerl Number: <br /> >'(� t66.Ahanmre Family u.� _- S.EPA ID Number <br /> Pac:ir{s-none <br /> : <br /> 1&.51gna::n6 -r tamaaaFaofity(xGeneratw! Month Day Yea <br /> z <br /> Mig.Haz?Ts':as:aRs;xx:Managementklematl CCCeS(Ie..C.pdeS lc:ha2adoee wd5le lreaiment dl8pp581.dna fery*lmg sss:ees;; <br /> Q .1. 2 2. <br /> I i.., <br /> 24.Oesgratsd Facuily Gkmsr ;cn CarSflmdcr.c`:eceiptolnazardous rnatadalt w4%d'mr the ma^.ifest except as ndec'in Item!So <br /> .m!vallmea flame Sgnabre ',+pnm Day Year <br /> EPA Fomn 8700-22(Rev.M51 Pr6sioas entien;are absnlate <br />