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Please print or type.•Fomd.designedfor use on elite.( )typewdler.. Form A roved.OMB No.2050-0038.
<br /> UNIFORM WARDOUS. 1.Genemtor ID Numbe 2.1iagelof 3.15matgencyRasporishaPIW 4.Menlfaat Tracking Number
<br /> J L;Y A8TE MANIFEST ai ".1 133fdFY 1 2W-4&0.0jIW 013435269 JJ K .
<br /> 5.Gbnarelors Name and MailingAddrian . .. ;.,a.:,. .:;:Generators SkeAddrass(it inherent than mailing address)
<br /> AACIP(C tg0Wf.AW PT IF.RIG,AT1C11d
<br /> $T4,}SldTON.I'AdW5
<br /> Generalols Phone: `::f 3::-080.Od86i•', '. .., `: . •...
<br /> b.Transporter l.Compalry Namfl,: •, .;;: ': '::-..: - . ••f:,
<br /> .., ,,,,,:�:... ,. ... .U:9.EPA ID Numh9rr
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<br /> I.T)anaponar2 Company Nema ,9:EPAIDNumBer -
<br /> dd gg�� "•'��'`•'' `I"'' U.S.EPA ID Number
<br /> %FXER24W �A 01107 ENVIRONMEIVtA `. • :,. . . :n.. ... .
<br /> Faclill isphone. . . "'. ....�.�.:....,'
<br /> ` 9e. 96.US.00T DasPipeoq(induding ProperShl`pping tramo,.N??$:r;BtL,.�ekc,lO N::u..m..h.e.S.>. . .:::... . : iu
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<br /> .418YVa,ae Cadea
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<br /> No.. Type Guan6ly WWaI.
<br /> o1. Nigra.Fte�t >wA�Av¢C1 119�AtA t1ti(!li Irgil1n1W.:P ':.. . .e .. :, •:'. ',s�
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<br /> AjApeclal HandlingInstmclsons and Additional information -R-WelP" Er lit
<br /> 1JsP 3LGVES. 1iN's[71F: # ;5'0.3 7
<br /> 15.'GENERATOFeSiOFFENOR'S CERTIFtCATION:,I herehydedare thatlhe contents of he consignment am fullyend amumlelydesorbed abovehy the proper shipping Rome,and are classified„paeke'ge8,i,.
<br /> marked and labeledlplabarded,indak In airrespeca9n proper mndNon Por transport according to spoloeble intemaganaland national govemmanlal negotiations.Ifexpod ebipment end'Ism the Primeiy".:
<br /> Exporter;I mdiy lheUhe cuntenla ofgils,conilgnmenl wnfvrm tb the terms mthe atmdled EPAAcknaxlodgmenl m Conseni
<br /> I,aad'dy.thaplhevreale piiriimizetion atelemen(iden5fiad iri 40 CFR 262.27(e)(I(l em a large guan6ryganeleto!)a.0)'(Ifl am a small quandygeheramr)Is Irk,
<br /> Genemlorsl0lfelora Prin R ped.Narde' ' ,. .' .Signatum: ;,. Month '.•D,ey.;::, sac. .
<br /> e�# ear �3r `�.- . . ..
<br /> =+ 18.Inteme5onal9hipmenls. '•"
<br /> ❑Impodtb U.S. ❑Exaorlfrom U.S. Pod of'enliylriipl:
<br /> Trans signature(roieilpode.orily):. Date leeNnAUS;::
<br /> a' 171 Transporter Anmcxledgmehlof Rabaipl OfMetetlalp -
<br /> TmnlpomefCrnil me signature / Month Day '.Year
<br /> efl�_ / a r
<br /> Transporter 2 Prinlediryped Name r ' , Signature
<br /> Month. Day ., Yea(
<br /> 18.Dlscrepanry .. . . .
<br /> its.Discrepancy lndimfian Si 6aangy 11 Type Full Ra
<br /> ❑RB61due ❑PadelRejeegon lection
<br /> Manifed Reference Number,
<br /> 18b,Alternate Facility(or Generator) U.S.EPAID Number
<br /> U
<br /> w Faditys Phan:
<br /> cz G Signature ofAltemate Facility(oaGenerator)
<br /> Month Oay .Year
<br /> g19.11aremabs Waste Rapid Management Method Codes(i.e.•rodeafor hazardous Wei bealment,dieposal,pod peopling eyeibems) '
<br /> I/ 20.Dealgnated Facility Onew or Opened Certdlradon offacelptof hauitlaus materials i=aradby ma nd t exbetes noted in Rem.18a '
<br /> Prim drryped Name, - g N
<br /> 1 otic � ' .Vti�t:c:+.v. ,�. I:1:. �-;.4 f . Zy.:.i
<br /> �, .(�r ,pnN ear
<br /> �•'�” I A , `rte
<br /> EPA Form 8700-22(Rev.U5) PrWolisetlitionsareobsolete. ' r'"r' ' ' TRANSPORTER'S COPY
<br /> ONI 'HA01 M 1JN019—�-400: 11=Sl06 'S 'dpW
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