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0 0 <br /> Please print or type.(Fame designed for use on elite(12-pitch)typewnler.) <br /> 1.GeneretorlD Number Form Approved,DMB No.2050-0039 <br /> UNIFORM HAZARDDUS 2.Page 1 a 3.�rgerwy Response phone 4.Manrest Tracking Number <br /> WASTEMANIFEST C LaaB alba ! �/I S-7 007436170 FLE <br /> 5-GQ atofs Name and Mal, <br /> , �Aa� 1)f J¢ Geee oh Sle Addm:(d d1mrenl man mailing Rous <br /> aF6 oyd Cai 75� <br /> 5 � <br /> GeneraWts phase <br /> rarKpcner Com�rry eme+ <br /> `1l nn T � U.S.EPAID Member —7D <br /> ..Trans Her2 Company )nt l i� Jill � )\ V V� ' <br /> W Name <br /> .S. A ID Number <br /> 8.Dar ;gpaletl FOnRAy ameand 5' Atltlreas r <br /> AVY S �� c+�{��,� I 1 ' U.S.EPA <br /> � J 3Y`H'T'�T p�d� <br /> Fa u 's ,. 3.. too <br /> ga. gb.U.S.DDT Doemptbn fmduding Proper SNPPIN Name,Huard Clea,ID Nwn6ec 78.CoMelrers <br /> HM and Packing Group pf any)) 1f.Total 12.Unit 73.Waste Catles <br /> 1 No. Type Guantiry WfNol. <br /> o <br /> box I aNQSi t r 5( N oa$, SA�ivw� <br /> z 2, <br /> LU <br /> 3. <br /> 4. <br /> 74.SPecal HeMlirg Inshueiort and Addi oral nfomlaaon <br /> �� D�aJla7�'9'S- lo �pl� Sia-o�I `� <br /> 15, GENERATDR'S10FFERORS CERTm in asrespwerebydealare Net the conlenIs 0 Mrs consl9nment are fafyand amreterydesoihed ebore by the properahipping name.and are classified,cardoged. <br /> marked and Labelned taeconlossma,an da re Inallrespects in pmpermrMition for 4erapW according bapplicable tnlemadonal and nalianal gorernmenml regulelgis.Ilossonshipmentand Iamthe Primary <br /> Exporter, sandy Nal Pce cMlenlsd this anslgnmenl conform Wthe terms of VeatldNetl EPAAcknavrledgmenl of Conant. <br /> icer!"tmewaalemWm¢abonslatemenl ldprllfiad in40 CFR26227(a)(d lama large quanurygenemla)a@)(If lama smadqua ilaygen r true <br /> - <br /> eneeon.Pante yoed Name quo <br /> on By ar <br /> r rdm <br /> A4 oA k. �. <br /> 1 .Intomosonuo Or anumns <br /> ❑I spen to US. LJ Expand from U.S. Purl ofentryle)il' <br /> Toravelersf rwWrelforer II <br /> 11.TmnN der AdrwMedg�ot Receiplof Materials Dale leavin U.S.: <br /> r n o r 1 An y(r ped Name <br /> °- 1\l 1) 19nau on o r <br /> ems'' Y <br /> i TransPoder2 PdnledRYPed Nave ` ig tum ` 1 <br /> Kedp a aY ear <br /> f <br /> } 10.Dlecrapanay <br /> 18a.Discrepancy Indicator Space ❑paanuly ❑type ❑Residue <br /> ❑P9NdI Refection ❑EUV Relacgos <br /> .- Abemale F.cely(or Generator) Mend est Reference fOI. <br /> =1 U.S.EPA ID Number <br /> U <br /> Q <br /> LL Face a Pnone. <br /> ow 180.Signature OfAllsmate Facdily(or Genera oN <br /> Q Month pay year <br /> Z <br /> %Hazardous Waste Report Management Method Codes(ie.,rntles for harardous waste treatment,disposal and recycling cyc ng s ystems) <br /> 4, <br /> 1 ZO.Deslgnaed Faalily 0rvnera opme&.Certification of maeipt of haeardous materiels wremtl by the manifest escepl as noted in Item tea <br /> Prin'3NFYped Name <br /> 5ignalure Month y year <br />