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Please pf"Ing. Fohl,designedfor use on alto 112-pitch3 Npe++rA®f•) Form Approved,OMB No.2950-0939 <br /> L fanrmmrlD Nnmbm 2.I e1pl 9. go . Responr:Phone 11 1,ntioaf Tnckbl9UVMbaf <br /> UNIFORMHA7ARDOUS may- .--5�� - 015384258 JJK <br /> WASTE MANIFEST QO b / y 7 <br /> i.Gauermm's Nmne end blouse Adtlre}s 15.meMs Sec"W"",0 dew.nl Nan.ndiymg IIdJleesl <br /> ECS /rte �/N1NG G� C S�' %.��'c�r✓ �121� <br /> Generala'a('lisuc' <br /> I7U`P�d U.S EPAIO Num xer <br /> 6:Tmnpnlor'.I Cmnpany mama <br /> i.Tmml'erlar2CnmpmnY Warns , zr (!,-� ! I I O& ! � S.F,p4-sol V-S / - <br /> it.Desipnplotl Fnc-0Ily Name eraSinAWresa �-7'�I./ U.S.EPA ID Number <br /> P,d4rs Phone: <br /> ga. 9b.U.S.DOT DasMp<on Indud'mg Proper Shipping Hama,Hazard Class,ID Number, 10.Containers 1t Total 12,Unh 17.Wasie Codes <br /> khg Gnup(dany)) No. Tyls Quantity WI.Nal. <br /> 14A and Pxcf <br /> X <br /> Iz+l <br /> cD <br /> I <br /> 14. I 1 <br /> T i <br /> iSpedoll+tmdlingk'sur; ulnsarxlArklgkmd lnfoimaBm <br /> >,), liMi l CAI�-I,-�'T <br /> 15. GENERATOR'9fOFFEROfi'SCERTIFICATION-Iherebydedarelhat the conHntsoil-c4s,-MemldlyaMeccuratetydesaibed above by the propershlppkq name,end are dasedwd,packaged. <br /> marked and labelud+plaaarded,and are in all respects In proper condition be transport according to applicable Inlemallonaland mallonal governmental regulations.If export shipment and I em the Primary <br /> Exporter.I ceaifythat the contents of Ws consignment conform to the terms of the attached EPAAcknoeledgmemt of Consent. <br /> I certify hal the waste minimization statement Identified to 40 CFR 262271a)(il l am a large q,,l gmmtulm)or(b)(IlLien a smell auanMvgenmmar)m We, fAmh Day Year <br /> Cenermol' c fhimeNTyped Nome SkPalnm — ` Da . <br /> 1. <br /> —1 ul'bo nn ., apme a, LJ bnpod to U.S. l_I Export from U.S. Pod of enlrylexe: <br /> _. <br /> Z TrmrlOttal Vre"oum(fu exports pmyk Date lcadrlg U.'.. <br /> Od 17.TmnsporterAAnowledgment of Receipt of Materials <br /> US 91yrr o �� Alorlgr Day Yea <br /> Trnnspallez l Pnh:erUrypeJ Norco <br /> kol% <br /> Z 'bwcrrortnt 2 P n1eMIYP�Name YJgnshue IAonN Day Year <br /> 4 <br /> K <br /> 1- <br /> 18,Discrepancy �I <br /> IBe.Dlsaepenrq Indication Space O Ouen0ly h'!' I"tJ sl ❑Festal RejectionLIFdI Rejection <br /> IL.. MW4..-t Rnhmree Nnngmr, <br /> IBb:Ni:.:rs;Fadtry(ar Generalorj - .I' ` U.S.EPA ID tIm+Mr <br /> J <br /> U <br /> F,cmys Phone: well Oat <br /> IF.,Slpnmuw 01Tl1d1mle Fxlsry(aGererater) PPEIVA)7ISEf2`J!CES <br /> a <br /> z <br /> � 19.Hazardaua Waste Roppn Management Method Codes li.n.,codas for hazardous waste Irealment,disposal,and nrx.ya.un systems) <br /> t / -Z 2 , c <br /> 20,Designated Facility Owner or Operator:Cert7lcelion of mcmg+l of hazardous materials covered by the mengesl except as Med In Item 102 <br /> 1 SgihalJla µNilh Uny Ynar <br /> EPA Fond 8700P21Rev.3-0 ) Previous eNgons are ohsolete. I?C:;'G!IAT F0 I; C IL 17Y TO DESTINAT10N S TAT I=(IF R FOISIRC D) <br />