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Fax Server 8/6/2015 4:01 :05 PM PAGE 18/046 Fax Se CEI►V/E1) <br /> • • <br /> AUUGG0 6��20071�5� <br /> Please Print or type.(Foml designed For use on efle(12PIWl RON dVTAL <br /> UMFORMHUARDOUS 1.6el-l—lD NmrdvF <br /> WASTE MANIFEST ,? 1 0 f, 0 1 p :. 2Pegetd 3.Fa-s Res wPhm, 4.ManlfestTrafti! CRIT <br /> 7 VES <br /> S.Gelaatoys Name and MallingAddleas <br /> 0EA ((uddNerent tllanmaRn9aadlsaJ <br /> Ganenters PlollR sb! <br /> 6.Trtnepadm l Company <br /> G;:1.!i..4..'�^s' _'i:'i1' o f $i .I,:wi, UI EPA ID <br /> 7.Tra1lyeler2CompelyNeme i li ': .: 5 <br /> U.S EM ID Nmeber <br /> e.Deslgnaled FaoTly Name and BaeAddmu,r,.. <br /> :•c+.s:ir. >£:w1-riiVk,i+!.SQL;7TI�IYI' U.S.EPAIDNumber <br /> 9a. **U.S.DOTDeNafpasl kk4V ftW&kft Name•Ha1aldWq IDNUm6m 10.CaNeinma .. <br /> Vad encliew pOmVBf� N.TOW 12.IAd 13.WeeMQbs <br /> O 1' ?1;17.(.: ai I{G 7.n._a l•" • ..:':7c• :e. W. Type O-W 1MNq. <br /> All <br /> 2' �'ill:i:._.5t.�.cF7;••dt; .gc•:;It=!;(:.. :fir. ....... <br /> : :Af <br /> a <br /> 4, j <br /> 14.Special Nfomea5m I'---..•�-- <br /> .._:.(.i.ii Na., ':) ......• Nl.bid":4f{'..AiCYKFf(.T siR T .1:1kff 1•i.Fl:•?RRt'at'iil'1.)Y1Y. <br /> 15. GENERATOR'SrOFFE0.0R'3 CERTIFlCA77QN:IMrebYdaderatalthIIII, j:rjejnngm aye fVIli aM <br /> marked Smd kbeledlomrded'mm N aB IWI h pmpa•mndkn for eaxirtkHdesmMed above by 8lapmpersfoppmg roma,mtl are dassieed,pedaged, <br /> EYpslan1mNFYMatda mmm�b o(Nk mnsignmenlmnformbtla Iemr:dhI �rg m applimit"m'offe"ora and n�Iliamm"I myMtie:¢.If arpolt shipmam and i am the lad <br /> mrelymmmewazhm 00111 on sl atemenskleatentoc I10 lame(III dim AdnoMetlgmantof C=Im, <br /> MIT <br /> Gme.. P7nledRyped Name ()f aye guaney genmaW)a(e)(di em alatelqueaft genal is hue. <br /> 8ignaMre <br /> . Mwa1 GaY Yam <br /> F 16.hnemahonal NItmenk <br /> ❑hmeon m U.S, <br /> = Tlmnpormr si9iamrt , ea(wM oldyJ: ❑Fapud ran UB Patalmdylept <br /> W 1T.Tmesp.M A*WdedgmartolROgptmMmadda Dgleleavilg U.S: <br /> Trtnsparterl Pdnlaal"ad Name SklabR . <br /> aDryY <br /> ear" <br /> Q Trtreponer2 PdIafwr <br /> Month Day Year <br /> 19.Oisaepaxy I�'1 <br /> 186 DlsmepamY wicatz,Spam ❑Duardty ❑Type <br /> ❑Revtloe ❑Pallial ReJeabn ❑FVa Rejsdon <br /> 18b.Mamie FaI(or Generals) MaNfeq RemrelNe Number <br /> U.S.EPA le Number <br /> U <br /> LL Faalpys Phone: <br /> w I8r_SViloarenfA6am le Faalay(aOeneWoQ <br /> iMarth Uay Year <br /> W19.Haterdous Wash Repel Menagement MelSod Codes(M,codes far buzmaae a ae heaimra deposal,and raryWrgayslmns) <br /> 3. <br /> 4, <br /> 1 20 De ig a d Fatl1y Mmr or DPe am CatlB a8on dmmip o ba aMo s nutanals ma ed by me madrastaaapt a III M nem 18a <br /> md7yped Nama SlgnaMrt <br /> hbmh DaY Year <br /> EPA Form 8700,22(Rev-3.05( Pr8vious egos are obsolele. <br /> GENERATOR'S INITIAL COPY <br />