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Pfea I 5eprintertype.(Foundesi ned for use on elite(U-pitch)typewriter) Form Approved.OMB-No,2050-0030 <br /> 1,Generator ID Number 2.PageResponse Phone 4.Man St Tracking Number <br /> UtW�KYWJIIRDOUS f1L:04 -11,� '� 1� 1) 1� —7 1'� <br /> WAVE Mftrw Aj I LL1. I U 'j : '."'i 4 "/,:rC <br /> " A S KS- <br /> S.Genaratbrs.Name and Mailing Address Generators Site Address(if different than rnaAng address) <br /> Generator's Phom W5" - <br /> 8.Tfansgotter 1 Compaq Name S.EPA ID Number <br /> 7.Transporter 2 Corrt;)3ny Nome U.S-EPA 10 Number <br /> B.Designated Facirty Name and Sits Address 54"T1* F-'H �YFTFMS, INC. 0 C,101 It 6 ce U.S,EPA ID Numbee <br /> 600 8UTH STRFET <br /> Facility's Ph": j <br /> 9a, 9b.U.S.DOT Dgsc(jpltQn{including Proper Shitpitiog Nam,Hazard Class,0 Number, 10.Containers I I.Total a Unit <br /> HM and Packing Group(if any)) 11, <br /> Type Quantity WIlVol. 1�-Waste Codes <br /> '-#""ZM?i)us VOTE, 1110JIP 1121-41 <br /> rj4,5,,'M i,41ASHU SOLUTION) --- <br /> Uj <br /> 3. <br /> 4. <br /> 14.SpecW Handling)nstructions and Ad0onal Information SK TN" <br /> ajLT' r 9�? 7 Ft�, T f G57 TA L-dU&jL9-1ENT LA-W-Lr�-S A,13 <br /> a GENERATOR'SIOFFEROR'S CERTIFICATION: P hereby declare that the contents of ilea congjqnmirt are filly and nocurate[y clescrit*6 atova by the proper shipping name,and are dqsffmd,packaged, <br /> marked and labtle,&p1scardLd,and are in all respects in proper ow)dition for transport according to applicable internoonal and national governmental m9ulatim-,If export shipment and I am the Primary <br /> Exporter,I oe*that(he contents of this consignment conform to the terms of the 2113r9x-d EPAAc1oiN*07wI of Consent. <br /> I certify that to waste minimization statement idmfilied i1140 CFR 26227(a)(it I am a rdtge quanUly generator)or(b)fit I am a small quanfity generator}is true, <br /> rem-tor'SlOfferoes PrinledrTyped Name Srgna,T' Month Day Year <br /> 1&.Intamal oval ShiPments <br /> EImport toUZ. Expon from u. 'Pon of entr6xit <br /> Transporter Signature(for exports only): Date leaving U.S,; <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transponer 1priltedrrypEd Name I Signature Month Day Year <br /> U) <br /> Tr%importer 2 FOnjed/Typed Name Signature Month Day year <br /> I B.Discrepancy <br /> lea,Discrepancy Indication Space 0 QuantityEl Type Residue El Partial Rejection Full R,i.10,, <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA fD Number <br /> L) <br /> J. F'dliy"phone: <br /> LLj 18c.Signature afAfternala Facility(or Generator) Month Day Year <br /> 19,Hazardous WaVa Repor(Managemant Method CodasCi,e,,oodes for hazardous waste(reatmcm,dispwt.and recycling systems) <br /> io <br /> In <br /> 20,Designated FaOtyOwner or Operator;Cediriowion of receipt of hazardous maletials covered by the manifest 0=pI as noted in JITyn 18a <br /> Pdntedl'lyped NAM, -Ngnature Month Day Year <br /> fjr:Lc;fnj I ktnrr"'i <br /> 899-3 TEO/Md O6Z-1 916698EKG AG 1;'2s-WOE sz:zl OTI-K-10 <br />