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MIMMq a� <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Pags 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST G cGW5 {I 1W0r--,v7z- --7za1 010875200 JJ K <br /> 5.Generators Name an ailing rens G omwes Site Address(if different than mailing addressl <br /> xn pv Z 5 S�c� coir /v,. <br /> Generator's Pwm.. <br /> fi.Transporter mpany a U.S.EPA ID Number <br /> jrho <br /> U SF,EPA <br /> D Number <br /> 7,7ranspongrYp��n7y Name fi� 1�9DumO� j('3 SD <br /> B.DeS. ign�Nam�te/ rens ./._� r ��sryp g♦ 0 J"C Ci U.S.EPA ID Number J <br /> Facility�h� L+ 40� �'/��I1 T/G1 4 UY VJ O V///J 1-1 /0 <br /> 53 <br /> ga 9b.U.S.DOT Description(including Aper Nipping Name,Retard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No, Type Quantity WtuVW. 13.Waste Codes <br /> C' n�.os � �� �.� q VIM ��so 16) 'DOUrb <br /> 1. <br /> ����s�e,ea�I , ,�r�)"/�- /)� CF /1-43 <br /> I ..Special Handling In N and Additional lnfon1amr, <br /> cry s►�2 � �c c.� <br /> w <br /> 15. G NERAT R'SIOFFEROR-S C TIFiCATION: hereby dedare that the canknls of(h's co ign nt are tally a rtamtety scribed above by pfoperzh,ppq name,and are classified,packaged, <br /> marked and lobeledlpacarded,and are in ail respects in proper condition for tampon according to applicable intemalional and rational govemmenal regulations.It export shipment and I am the Primary <br /> Exporter,I cenity that the contents of Ihis consignment conform m Ne terms of the attached EPA Acknowledgment of Consent <br /> I cemty Nat the yasle mirumtr l statement IEootified in 40 CFR 282.27(a)(if I am a targe puerility generator)w(b)(if I am a small quantity generator)is true, <br /> G . ors;0ffl PdniedRyped N Sg r Month Day Year <br /> -b 1 16.Inlernational Shipments <br /> F- Import to U.S. ❑Export Irom X Port of en"lexrrt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Tmnsponer Arkmwed not of Receipt of Materials <br /> Tmnspatar 1 Phnfieftipel Name Signa _ th D7y Year <br /> NC 144 G V <br /> Z framponerZIAInIedflypecil e S na MonM Day Year <br /> r! a' z�-, G � l <br /> 18.Discrepancy <br /> �r 18a.Discrepancy lmlicatun Space ❑ Quantity ❑ El Reedion <br /> ❑Type (' Residue ' Partial Rejccliao j <br /> MlnstReterence Number. <br /> 181.Atlemato Fadlity(a Gismin tor) U.S.EPA Io Number <br /> U pp / _ [[� <br /> LL <br /> Paul Phone -1�'��46'l)Tl.J ��:il.r` <br /> w 18c Signature of Aitemate Faulty(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Cafes(Le.,codes for hazardous vrasle madment,disposal,and recycling systems) <br /> 0 1. -// 2. -/ 3 <br /> 20.Designated Fadlity Omer or 0 tor:Cerdhratiun of receipt o ardous materals covered by the manifest except as noted in I'am 8a <br /> Pnrd me � $i re Month DayYear <br /> J_ <br /> EPA Fo 700-22(Rey.3-05) Previous editions are obsolete. D „Ila HATED FACILITY TQ DESTINATION STATE(IF REQUIRED) <br />