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Pleasepdnlortype.IFormdesicnetlfcrusermelitall2-gtchlNPe%wftr-) <br /> Farm Approved.OME No.E50-0039 <br /> 79—N Kal. <br /> bar 2.Paglelaf 3 Emawarlcy <br /> UNIFORM HAZARDOUS 1.Geneexor 1)Nuv' ...... <br /> WASTE MANIFEST SKS <br /> 5.Genersdars Name and Mailingmdass as(I:d*dMni than WIWQ B=S$) <br /> Generaws U.$.EPAlDNGnIher <br /> 6 Tnansporter I company Name <br /> U S.EPAID Nunef <br /> 7.Twsporlef 2 CwparyWffoe <br /> �4"j <br /> 8 Dasiqla=Foafty,Nano and SfteAdCMn U.S.bVAHJ Number <br /> kr-Facial <br /> ger. 9b U.S.DOT 09SC43don(,mud rg PMW Sipprg Nam Hazar.Class.10 N"W. 10,conflainels 11.Total 12.Unit 13 Was4a codes <br /> HIM and Pa&jM Group(I ar-0 IN Type Quantity Wuw. <br /> IX <br /> 0 <br /> 3. ... .... <br /> 4, <br /> Ta <br /> —i <br /> DEPAM11,11- <br /> 14.Special landing lnsS fiow and Addftnal lofOrm tiOn <br /> 15, GENERATOWS10IFFERGIVS CERTIFICATION�l OerebydedamtratMeccnulsmiNswagnnemam tulyancaumnatsaYdewbed above by Meppoper shipping name,a'dareceassified,packagE4 <br /> wjej and laintedip.ricarded,and are hall mspanin famper uandifian forranspwt according to apolkable mtemalureVandnaJoael gmNnoloaRIBI rfigul8fli HOW sPilarnant and(an LIM Primary <br /> Expullar,I ceftfy tgl-.he cwtem of Ida consignment con1=10 the hems of the ermined EPAACIflowledgmentG1 C;oMsen <br /> lceltly Inatthe waste minimtradon statement Identified in 40 CFR 262.27(a)(d I son a large quantity generalar)or(b)fillarn a sural'quand,.y genevu;orl Is rue. <br /> Generator;Z—ffuOT'S PJAed!Ryfed Nannie Signature Month Day Year <br /> 16.IntamsLonal Sh4nnents, <br /> II)POrt to U.S. El Ewt torn us Portofentylent <br /> Tmns33ftr signature darexports onty:: Data Wavi.It S, <br /> W 17.TrarWrlar Ackn%detman!of Recelp or y0odW <br /> w - <br /> t2 Trampofta I Panbe5fryped Nara Siqlature Vcrdh Day YM <br /> Za Traraporter21'dreedITpedNanne SigInature Month Day Year <br /> ti <br /> 18,Discrepancy <br /> laa-Oischapawy Indintim Span ❑ Ouaniity [Tryn DReatin 0 Pefial R4.mn ONE Rejedor <br /> 11 Manifest Refeence Number. <br /> 18b.Alsernate Fadft(x Ca Ioj U.S.wA 10 Nurnha- <br /> Mrfty's Phov: Moral Day Year <br /> w 15c.SignsuireorAtenneseFaciltyfw0enucator) <br /> 19.}mrdx$Waste Repos VanEgelSntMeuodCOdOS:je,,cGdesforhaudousmL"anont.dspsal,w4mydingsystems) <br /> 2. 3, 4. <br /> S Pdnr�rlyyed thanegn-wa With Day Year <br /> EPA:arm 8700-22(Rev 3-05) pleVlOUS 6djans are olosoate. C-ENERATOR'S INMAL COPY <br /> 699L-9M60Z PJISPIeA ljeqlV 1369:90'L 00 deS <br />