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Piracy nftniwtv-s fFnim ries ane. for use on eine! 2-pP1cr01vpewn1erJ <br />Form Approved. OMS No. 2050-0039 <br />EPA Form 87DO-22 iRev. 3-05) Previous edibitras are bb5dele UrNMMAI tin Q livi 1 am" t.War­ <br />Figure 4: Manifest from Hazardous Waste Pick-up 10/12/2011 3> 'rZ C -- <br />(Resulting from the missing Accumulation Start Date) <br />UNIFORM HAZARDOUS I G,ine-ilIcr ID N `tv <br />2 Page I e <br />3 EmI RiII Ph-ne <br />4. MI slTracking Number <br />I H28301.24 SKS <br />WASTE MANIFEST <br />5, Grearlat'sNa-, ar,1 Var-ingAftess Generalaft SileAddans (I! saiiererri Pan ma m address) <br />NINE a I Nr <br />17000 120 <br />R I PON CA Ir.)366 <br />emme, pmw <br />8. pn US EPA 11) 4umtef <br />TUFAPDIW I erm" <br />SArET" <br />7.7rdaspovier 2 CcarI Naim U.S EPA !Mmw <br />8 Des Ignored Facl ;y Name and Sale Address 9AFFI'Y—KLFEN SYSTEMS I WC U.S.. EPA 10 kurribw <br />M2' CCOPFR CREEX iibAD <br />TON, TX 76206 <br />Dr_NFacaw <br />t <br />�fi PhDr*. <br />9a. <br />96 U S DOT Descoop6m (01I %W. S" Mg Narrate. H&I Cass Q ya.rratv <br />10 Conlaners <br />11 TOW <br />12 U1A <br />13. Waste Codes <br />No <br />Type <br />Kv <br />and piackin G -I (I! any)) <br />Duarabiry <br />WI <br />WASTE FLAMMHbU. LIUUIDS, N.O.S. <br />i= 0132 00315 '0105 <br />o <br />(NETHAN01., PiFTHYL ETHYL- KETIONF) 3 UN199.3 <br />P13 111 <br />0001 213 <br />LU <br />2w� <br />E -4314i=1 TECE. <br />M9 <br />"NON RCRA HAZARDOUS WASTE SOLID <br />AM <br />P <br />Qui - <br />(LITHILM ION BATTERIES) <br />P49N RCRA HPIARDOUS WASTE SM -10 <br />DM <br />P <br />35r DOTS <br />fusciRAW AND OIL) <br />Riei <br />14 Specht Hand*Vi;;;CW;;dAdd111VI SK SH I P421053!"*41- 371458 C5Q; <br />-7 <br />1)LkLj1)128-2)6E #M4 <br />24 PR FRArw_Ncy C-60-468-1760 (&*ETY-KLEEN CcoqRAM #94138) <br />vie nirrovrN rn jizr qimc�inti m.jT rnPQT97P,7-A1(h7A 1,1.1.71 rir,%%i tJ^-71tll <br />15 GENERATOR'S10IFFEROWS CERTIFICATION: I hvebyd0dM OW 11* CDt4eft OfftUFiOVM-ll OM MY and JCcwI cescnt,.-Al abon try was prom shpiang name. and we cuss fed. PaI <br />marked and am an al respadS in pWw oradirten 1w trarspW Kmnkg to acap, rI Vternaab" arod raaWal rp-wnmel'a regdabms I OW shpTenl and I am Be Pritnary <br />cianilair ID"*rosafere oey-d*dEPAAcko*iedgw*niolCtnsaiI <br />I per !y m the wave �,zaw, staterraera WeInMed In 40 CFR 262 27(a) (0, 0 am a LaI areaniarf generates) or (b) (d I am a swat quanbri reareraI is true. <br />Ge.7a:esY0!`&,&s Pr"PcYTyped Nam Sr,mawrc Wcantl Day Yew <br />F- <br />16 Inle7w6o'.21 Sft;merds <br />Ll Inrpdrl Ie U.S i_J Expoa 1,C. U 5 Pal of Kiry"e.4 <br />Twsponer sqna:axaa i1of aspens CII Owe eawq U S <br />LU ICE <br />V TMWNA&nDWw,1ed:)-1re" d ReceplefMama's <br />Transporter I ProtedrTyped Name Sqnalave kbrAh Dairy Yew <br />Z <br />x <br />Transiacarier 2 PrintalType-i N" SiI m7m Day Year <br />18 Dscrepancy, <br />I& GsaephI lard cation Space❑ Type D ReI ❑ lawba! Rete-' El Fu I Rqed,car <br />I <br />Manes: Reltrence Nimbe!. <br />18b Mernate Faciaty, im, Generarax) US EPA M Nurrbe, <br />Facraly's Prone <br />jec Sgararpre ol Anennate Faafly (or Ge"rabon <br />III Day ym <br />Z <br />0 <br />19 HaraI Wase Repot P.Wagerearl Laces I, t. c�j-s For hxzA*dr ns waste breaI Isfu-sal. and yd. 9 syswn,$) <br />JpS <br />20 Des grated FaJq Nne, or OperaAct Ce,vI:,' cr of receipt oltatizainlim rra!,rtais mvered by ft marded ezcer, as r=4W an Item 10a <br />Preted7ywed Name S gaaakare Mmfh Day Year <br />EPA Form 87DO-22 iRev. 3-05) Previous edibitras are bb5dele UrNMMAI tin Q livi 1 am" t.War­ <br />Figure 4: Manifest from Hazardous Waste Pick-up 10/12/2011 3> 'rZ C -- <br />(Resulting from the missing Accumulation Start Date) <br />