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Form.Approved.OMB No.2050-0039 <br /> Please pnnt or type.(Form designed for use on elite(12-p Ich)typewriter.) <br /> 1.Generator ID Number 2.Page 1 of 3.Emergerny Response Phons tEPA1$D <br /> g Number7 C cUNIFORM HAZARDOUS C,P 3 �GJWASTE MANIFEST <br /> 5 Genemto's Name and Mtiling AddessGenerabr's Phone US Number <br /> E.Tmnsrxater 1 <br /> Uti,1,T.ID Numher <br /> kTransponor 2:; n^ary NWR' <br /> L S EPA iD Nu.nher <br /> Designated Fac,try Name and Site Address <br /> Favi 's Pr,ore: <br /> tU.Containers 71.Total 12.Unit 13.Waste Codes <br /> Ra 9b.U S.DOT Dascnpton(including Proper Shipping Name,Hazard Class,ID Number, 10. Type Quantify WINd. <br /> HM and Packing Group 14 any)) _ <br /> 4, r <br /> LIU <br /> 3 <br /> 4. <br /> 14.Spatial Hdrxll...lrsbucdcne end Addi'iona,.Informaton <br /> nme <br /> 15, GENERATOR'SIOFFEROWS CERTIFICATION: 1 hereby declarethatthe convents of Nis cansgnt arc fully and aavately described above by the proper snipping name,ori aro c assi9ed,packaged. <br /> marked and Izbeledlplecarded,and are In all respects in propercondilion for t2twpan according to applicable pander and national govemmentat regulations.d expnd shipment and I am the Primary <br /> Exporter,I clarity that the contents of tris wnsgnment amort to ho <br /> ta,s of the attached EPA Ac'9wredgmenlof)Censenl yg <br /> I certify that the waste miama8ton statement Identified In 40 CFR 282.27 a)(N I am a le a quanN eneratoO or(b of I am a anal quart t a tr0° Monty ay Year <br /> Genem oru08aryta P'nl yped Name ,� Signature�w' d {, <br /> 4 <br /> J 8.Intamakonal Shipments ❑Export fau US. Pon ofen"lexiP.........� ------------- <br /> F Import to US. Dote leaving U.S., <br /> Transporter signature ya exports only)'. <br /> W 17,TransporterArknmiedgmen of Receipt of MakrnalsMopitk Day yearSignetum �y <br /> TranspoN,1 ntedRyped Nef�e..rit <br /> Mum DdY Year <br /> `t " ' ll Siyrature s <br /> 2� Tnn,ro4er 2 Virtual lypen Name <br /> 18.Discrepancy �w C Pedis Rejedbn LJ Ful <br /> 0 <br /> 18a,Discrepancy Indimlbn Spam � puandry, ��Type <br /> R08que ReJedmn <br /> ManNest Relerenm Number: <br /> U.S.EPA IO Number <br /> 18b.Alternate Facility(or Gonamtor) <br /> J <br /> LL Fecilil)rs Phone: Monty Day Year <br /> I"— 8c.Signature ofANenate Facility(a Generator) <br /> 4 <br /> H 19.Flazamous Waste Render Management Method Codes(he.,codes for hazardous amts treatment.disposal and recycling systems) 4 <br /> w 1 2%r '� <br /> 20.Dcsigna,(m Facillty Owners OperatorsCeri&aUon orremipiof hazardous mFvnalswvered by Ne mangest except as rated in item 1ga anth Day Year <br /> : r�naNra <br /> nntpd,Typed <br /> T1 ' r <br /> EPA Form 8700-2'L(Rev.3-05) '.z.edil!ons are ohs0lrte. <br /> DESIGNATED FACILITY TO GENERATOR <br />