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<br /> um Fo"HAZARDOUS 1,Gefleral�r 10 Number 2.PW 1 of 3.Emenjanoy RoV"cn F*rM Approved.OMB No,21550-0039
<br /> WASTC MANIFEST 9; 1p se Phone Ji Manmnt Racking Wmber
<br /> 12751 SKS
<br /> 5,Genaralces Name and Mating Add,,,�, �--''A, -'' I .I)
<br /> Addra*'1'9-�,enl Man mailing address)
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<br /> S09'ri'l •KA,It; 1-� 13;11
<br /> OeneratoesPhone"',
<br /> 6.Transporter 1 Company Name
<br /> Fri." r A.4 U.S.EFA If)Number
<br /> 7.TFq
<br /> US.EPA!fl Nrunber
<br /> a.Oesrgnaled Facility Name and 5iteAddresa
<br /> 55 F US,EPA ID Numbei
<br /> A M N T 0
<br /> 9.4 1s el 6 8
<br /> Facility's Phone:
<br /> ga. 96.u-s-DOT Description fjwJuding PiloperShippirlig Name,Hazard Class,ID Number,
<br /> HM and PacWng Group(a any)) 10.Containers 11,Total M UM
<br /> Na. Type Quantity VAMOL 13.Wasto Codes
<br /> kW7TE PAINT REA'ZI) MATEJUAL.., 011
<br /> F003 0,)l
<br /> -4 C�l
<br /> LU DO�S,VO 36,DO 3 9, DO 40)
<br /> Z 1? -6'37 T*RT--1 - - -- 0018
<br /> LM DOUS R4 wralr 11 IL
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<br /> M N11
<br /> Address n.T,e. me and Mating
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<br /> 14.Special Handling MaMto—ns and Additional Information
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<br /> M GENERA 0 13/0-�FFER'O-jpt&A�FI��TIT
<br /> an-d-a'ocunlkljd&sonhed aboye by the proper;7',p*—69M.and&M dmarfled,pkk�pd.
<br /> MaAW and IsWedPlacarded,and are in all mpeas in proper condition for transport 4=dng to-OPPlicablO ingematiOnaland naWnal governmental reguhWons.If e> rt OW I am the PMWY
<br /> Exo"r`l certify that the oontLnts of this OWSIgnment WfOm to ft terms of the attached EPAAch*edqm8hj of consent,
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<br /> �ENIRA 2RO
<br /> 'J"d an 1'� I
<br /> n',I certify
<br /> t the
<br /> certify
<br /> 'tt waste
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<br /> th, he w -,n
<br /> Targe quantity I Certify that the waste minlmizatiO6 statement idtntified in 40 CFR M27(a)(if am a I
<br /> ,�J,r3jDff, ganerator)or (if I am atarnall Quajtf4
<br /> ..r�Pont T
<br /> Geri�cajig tura
<br /> p flIed[Typed Name
<br /> pjDfferces PO erator)is brw.
<br /> 16.Inlemational Shipmen%
<br /> ElImpolt(0 U.S. aport F.M U.S, of eoyAwt:
<br /> Transponel signature(for exports ordy),-
<br /> Oato leaving V.,S,:
<br /> YmupcdL r Acknowjejqrw%t of Receipt of tAajerjals
<br /> Transpo erl6ni
<br /> Prin!edff
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<br /> n po d*nl=lyped Name 7iyl.
<br /> Cn
<br /> SIgnalure Monty Day Year
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<br /> 15,Discfepancy
<br /> 168.Di=eDancy Indication SpOC@
<br /> El Quantity Type El Residua ElpotlaiRmeco, ❑F.11 R.*Ow
<br /> 136NtemateFauRty(or Gorofator)
<br /> Manifest Reference Number,
<br /> U.EPA 10 Number
<br /> Facility's phow
<br /> 11k.Signature OIM77te Fachly—(-Generator) luonlh Day
<br /> Year
<br /> 0
<br /> 11.Hazardous Wagle Raport Management Method Codes(j,e.,codes for hazardous waste treatment,disposal,and recycling syslemt)
<br /> 4.
<br /> 3
<br /> 20,Designated Facility C*Per orCperator-.Gerffication of W61PI of hazardous maieli*ODvored by the manifest except as nOW in—Item 1 '
<br /> P,A Form 8700,22(Rev.3-45) Previous^ �t ons are ohsa(e#e. QFRlfyf�€�tTFn t<eru try Tri r_r�nrrea Rrnr�c.T�Tr..r ..�.........._, �I
<br /> 899-E IZOIO106 06Z-1 9T6�92E9I6 U@9T�-A91;es-WOHE TZ :ZT OT ,-8T-TO
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