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...,E 1. <br /> Please print or type.(Form designed for use on elite(12-pitch)typewfier.) 5f Fotm ved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generals lD Nr,mberGf��y7() 6 2.Page laf 3.Emeegericy Response Phag .ManMatt Tmckln Numberm <br /> WAS7E MANIFEST ``11 of W43-01_5q 0001�L2838 JJK <br /> S.GaAe2 E Name and MeiirgpQaress GematMs$de Add (a di8arenl Nan maB address <br /> 3 <br /> lO�j90 ort NJe 7 , Qoar� <br /> /etlwto p�ae K �(oLZfl S� lsI c)93io5 <br /> cerremla:Prone: k W—2 5. 5 2 <br /> 6,Transpoder 1 Company Name U.S.EPA ID NwMa <br /> MOQ< u E►����au - � `xtlkcrs ?vc <'n o t N2�3 <br /> 7.Tianspoder 2 CX Name <br /> rr\ ,Y r II OS�EPA ID Number <br /> t `6C t1., ((!(, x.F'I L. <br /> B. Ind FadWy Name and She Address ` f •� /. <br /> I(010 1,0 vbI r`1 ST U.S.EPA ID Number <br /> fit, 6`0HH CA �0�I3 <br /> F Ph": OO • 07} ' -11 c: V) saev�,c�r� <br /> 96. 9b.U.S.DOTDescltption(inducting Proper Slappeg Name.Hazard Class,ID Nunber, <br /> HM and Packing Grow(dany)) 10'coae:wrs 11.TO <br /> Q.Unit <br /> 1'UM {'- I I UOSTC- I S f"(o U v i No. Type oaamay Will 13,Waste Cold, <br /> X �� o,u o.s 9 0l or- <br /> 2. <br /> F 5 �l axi <br /> r )zz <br /> � 2. <br /> 3. ryVOSA1.TeE1TMENl I WAS KECENED, NDIFD A 1/ <br /> 'r hrs OeAMFp TO nDi,aY Tl@ RIUs QSBY OVERyp t Po StillIII !@aT sly O <br /> 1�(tIN VtRONEMMCMEM}NNTAL n10TE1Crfall woFTDa:I aO�,A�NC nIE FACDITl 1r,Ys.SIP <br /> a. <br /> CYC CONIROL <br /> c3lAvrs TO STAiP REwunoes, coos Y ACT of r a r 0° b .. I.. HE LTH <br /> rmOADOl D�Rr aE�eFfrRFx(Ha wA a ONERTO RAy wlnl Ae ' <br /> AND ALL WA.1TP HAS OF 1aR `� SAe <br /> Ogja un ), ro <br /> 14.S at Heading instructions endbddNorW In Ki _ <br /> r <br /> 15. GENERATOR'SIOFFEROR'S CERPFICATION:I hereby declare that the mnmrrts of Nu rgnsgnmenl are h1F/aM accumtetydesabed above by that proper aNpping nameam am classified,packaged, <br /> marked and abe"I'moatded,and are in all respects In Pool Carol for Invi al according to applicable International xd national gpvemmenta rgulators.If expel shipal and I am the Primary <br /> Exporter.I ce8fy Nat Ne contents atlas consigmnent conform to the roma Of She atlaMed EPAAckrw mdgmantof Consent, <br /> lowthytha[slawastarna N;ntiprtygaemenl Wank%dN40CFR292.27(a)(41amelergequanely lorgagil ay mal quantlty genembr)bhue. <br /> Gerry noe Prue lyped Name nature <br /> A ,G ll ,_ Month Day Year <br /> J 16,sale aaI SNpments <br /> 7— <br /> El Import W U.S. ❑ExpMhan U.S. PM of entry/exit <br /> er <br /> ThIMI) sgnalure Oar exports call Date tearing U.S.: <br /> 17.Transporta Mhrneledisal of Rel of Maledels <br /> a Tmnslbrlal rmkdRyyed Name <br /> a f, Signa Month Day Year <br /> z5 / <br /> m r t �i ��l ..�—..7 ' Y., <br /> Q ran da2PrinleNfyped Na me- S afiae_' <br /> ¢ C gn - Month Day Year <br /> 1 18.DkaePancy <br /> 188.Discrepancy Indication Space Quantity ❑Type ❑Resitlue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 7Bb.Pllemale Fadliry(or Gmemta) U.S.EPA ID Number <br /> J <br /> U <br /> IaL Fachtyy Phone: <br /> nor 18c.S19"WreofAllerrale FacMy(a Generates) <br /> Month Day Year <br /> Z 4 <br /> NO 19.Hazardous Waste Report Manpenlenl Mal Codes(i.e..codes for hazardous waste heatarrenl,tl5posal,and recycling systems) <br /> 2. 3. <br /> 1 ' <br /> 20.Deygnaled Fal Owrreror Operator C,,fration of mceipl of hazardous materials covered by the manaool except as ndedin Ilam 18a <br /> PnnlectRyped Nape c' { r I r Signature r Moral Day Yper <br /> EPA Fonn 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />