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Jul 31 16 11:44a DELL20AJ&46-0677 P.1 <br /> 10 �4+� . c, , V\ ,L4wjo <br /> Phase Print or type.(Fcrrry desiciried for use on eldo(12-rich)lylevnifer.) Fen Approved.OMB No-206D41101 <br /> UNIFORM HAZARDOUS 11.CienotatorJONumbe, 2.Pagomf 3.EmetwqRseponsel <br /> WASTE MANIFEST <br /> 5.Gen—to,"s Nome and kifineAddress ?DD� Uenw",;SiIqAftwes(ff dilemortner maw address) <br /> ILU113.afary <br /> Gwerad&3 None: <br /> 11,Tnentemner1cmilowyNamet U-S.EPA ID Number <br /> 8,DelninatDO Feeley Name and SiloAddo"S" <br /> U.S.EPAIDNamber <br /> Fadli (slohmes � ,j, <br /> J <br /> go, WU.SLDOTD-mqAmpi*dMPMWSWPIMWne,HomwciowvNmdw, contalholy, 11.Total 1z Uat <br /> 11 Hfade HM 1.uld <br /> No. TA, Quantry WLW Codes <br /> _r <br /> "XII, 1) <br /> KtUCIV <br /> ENT <br /> P-- <br /> IBONMP-- <br /> 14. H.dfirg loMr�ima and A616onal fttjorma6m <br /> 5 T 3 Y -1- 1aG: '75, <br /> 15. 6EKMT0ffS00FFERDR'SCMFICATlM: 1 herSby0sciatnee"the ooreene of th's o'emilomoot M M1V 3PdoCAffaWY dmcrbOd above"Proper gbppkg name.aid ave danfied,pacloged, <br /> morlDd and atme6placarded,and are M all wsmch m pr*w mrdition for tranwort acomArg Is appka*inten ational aro nabonal"mmental regulations.if e*og Shomert and I am The ProW <br /> Exporter,I ce rffy that the content of fts consignment cmftm to lm terms of ft allymbed EPA Acknovwfixigmept of Consent <br /> I Deify M fie waste minink3lion statement iderelifed in CFR 26227(a) I an a IWW quantity pematx)w(b)(Irl am a wall quantity gener lor)is true. <br /> Month Day Yder <br /> 16.IrtemagoreW Slip eats <br /> Import to U.S. Upon,trom U.S. Parlof o". ext <br /> Tmnaparinr sigraluse rfor moons onii, Date lainang U.S.: <br /> 17.TranspoderAdcoloxiedymmi of Remp3l d M*rals <br /> Tronloao0n,I lorintdrTypod Noma Sgnature --Vonth—Day Year <br /> TwVoftr2Pm1SdFrWdNamS <br /> Signature MOMh Year <br /> 18.0vacrepanctF <br /> 18s.Dbomixency Indicalkon Spam onantly EITYP. ❑Reside ❑Partial Relcfil ❑fa Repmon <br /> Illb Altanmlpf:wiftvinrr-aneratar) Ma,feSe RelegemmNumber. US.:PA ID Nunneer <br /> zi <br /> FadityYPhonec <br /> moom Dry Year <br /> 19.HaeanktA tVaste Report Management MAW Godes(i.e. andes ki ha2andon toosto Irealmarn,disposal,Son recycling Symons) <br /> 2 <br /> 1 Z Designated!FICIMY OVVMT Of 01.11lDI CeffllCatiDn Of NyooV of raze*0 maledids owned by im meelifiest sectept as nolk in hom 18a <br /> seed—Mmo Sonalon, Month Do, Yaer <br /> EPA F3nnn 8700-22(Rov,US) Pradnmoddbflsaraobsa;ale <br />