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Phase pralt or hype.(Form des rxlti for use on Mite(I 2-pitch)typewriter.? form Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS t Cden"410r D Number 2 pegrs t of 3 E"eg�V p z A.Manifest Tracking Number <br /> WASTE MANIFEST ` T 0 0 4 7165 4 6 SKS <br /> Uarte>raU�r`5 Na'N, tiq Au'drnss Generatols SAr.Address td drfrorenl than fnatrig wfrues,} <br /> Generator's Phoria: <br /> r, S >ty.� U.S.EPA tl?Number .._______,....._....__...._. <br /> i w" <br /> 7 Trarsponu 2 Company Nares �0 S EPA tO Nine <br /> b OeArurled Iw*y Name and Site Artilum PLEA„HARJ3G,iS �;; �gx U q.EPA ID Nurzfer <br /> «p I-W <br /> RN <br /> Faiol t'e Po". <br /> q, 9_U.S.DOT fJtttatsq ger k g Pmts Stw;rpmg Name.Rarard Class.fD Numtw, 10,Corlt;•anars <br /> ttM OW Parking Group(d any)) <br /> NOW 10*300 i LXl HA4fiRDQUS WASTE <br /> a <br /> z <br /> w <br /> t e S�vti ti:i,xltvrg hu,rudiars xnu Aatf�aanu;tniwrnatrzu i <br /> --------- <br /> V) GENEUTOR'SIOFFEROR'S GERTiFICATION: trereuy aecWrs teat aw caaents nt tnis umsgnma .t we fuaq arlo wcuroteiy desa%bK!f Above by the proper skiiihwig nar€e,and we caawhed,packaotl, <br /> mamw and iat'hT4.";itaCarrfr#f.aw am as all rBSpKls ar prom ww jwn ka va45wrt actx"ng 0 apy*,atrie xuernauonai ano natirx"govenvfiantal rrri]LLfataN'4.I eaood shpnit ro art"E am ttu;prmily <br /> Expatur.i ta"u at usa contents of ftus mot conform to the terms of Ore attaCned EPA Ask r"Awkynnntof Gofuera <br /> I %W Ow drasW nwi-lbod>4t 4a hnl tkn'16tk9.n dG CFR 262 27W td U am s Iatyxr;tuanhty general")' r ib)tit I em a t 1f quartpty nlori is tnie <br /> 3etinr p1►nrW b Pr%, YTypW Naw SSU.: kloorM Day Year <br /> rn 6 riationai stupments 1 _� <br /> El Ext?an siforn U.S Peri of eqdytlexB <br /> 1ranaporta slijnwurm(kir expx%my: Crate tma•nrxd U`i <br /> uj <br /> 16— t i?r,s^tom,^cfir Rckn ftiitt d:4atenals __ <br /> Tra t ?-7,7r t'ymM Nam 5'sgtrawrrs _.... <br /> more, NY Yew <br /> Ttdm%(o lar 2 Pi•rtled.l�yw-o Now gay Year <br /> 15 <br /> ft L:+sixry �t ( <br /> ttla Discrepancy y hidxatatn S mte Lj GWan:hy ❑Type ! _1 Rasreue 1._J�; i , l Pamal Reja -7,FLA RwCW <br /> Mallrlmsl Reference Nondrer <br /> I= let,ru emeW haft tar Genels on US EPA W Ntarlbpr <br /> J <br /> U <br /> Faafm(s Pune. APR n 4 2015 <br /> W ?&c. re kJtenakr ariah•:orGawimra ) Wx;t+. Day Year <br /> ITA I <br /> !g.w,aaraaus JYaSie Reptxt fr a:rsgen+rertAaettl C,oe 'u lAe coc3cs a . rt . 7 _ u <br /> Lu <br /> 20 Oasrgnauus F ty CIwnar rx Otvrwm-GorliN abbe t f rc cso of Inwar0ou';matonaas covered rry tr>a rr rdssl except aS rXUA 0 ttem)as <br /> Print yr>ed Nam[! tine ... FRnr�+1i Day year <br /> EP)kFarm P7y�,,22.1Re 3`Q5},PrermusedtGesare obs-orale <br /> GENERATOR'S INITIkL COPY <br />