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_. — <br />rs P,. nrinMximP /fimm dPsinnrM fir uGP rm Plta (12- hch11vnewritar I <br />Form AnprDYed. DM$ No. 205G -W39 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM �HAZARDOUS 1 Generator IO Number 2. Page 1 al 3: Emagymcy Response, Pho1w 4,101anifestTradimitNumber <br />0 0 4 9 017 7 0 <br />WASTE MANIFEST .ELE <br />S. Germramrs Ninnea MadirgAddress eneratots Site dress . r maFrga rens) <br />GPLC LLC dba VMw T*Ary Products , <br />S St'sprter" <br />R <br />party U.S. EPAID Number <br />AdWZad Cies Wbd TMMW kit. PA CAF40=70MO <br />7. Transpader 2 Company Name U.S. EPAID Number <br />8. Dasomfleal Faciiry Naye arsi US -EPA ID Number <br />&to"ns" <br />8Ary95,11 <br />P� S BahN1V <br />t rimiom <br />Fault is PPho. <br />9e, gb. U.S. DOTOescrip6an (aitlud re Proper ShlPprg Nana, Hazard Cis, ID Number, <br />10. Containers <br />11. ow <br />i2. Unit <br />}3. Waste Codes <br />No. <br />Type <br />HM ami PacidAg Group Cdamy)) <br />WtfWl. <br />NA3877. Hasardaes waste,, SWW, au.s. {CM0110M, 9, <br />/p <br />t1G07 181 <br />X PGIB <br />"( <br />CQuaatlty <br />J � <br />P <br />w <br />z <br />w <br />14 Spacial Hannam, IrsnCoone and vxarwal Informal <br />PrOod Nbil 3111 Mwr4tt #. D3051 <br />1 Tt; 070128St133T5 c}DDI"i! 65_D <br />1,14P 1. <br />---- - ✓ ir�,rZ <br />13. CENERATOR'SlOFPEAOR`S CERYIFICATIO: relhai d ornmerts a this conegnmant arefully and adburatay daxxuiibsd above, Ey tw me, and we dessi7ed, packaged. <br />marked and labelefdplacaOed, and an, w all respects in proper wndrion Ie, twspat according to appNcaae interratiunal and naria:et govmnmental ragusaar,. 0 export shipmem anal I am ee Pra any <br />Exporter, I ceder that the amlerns ams ceniminmem conform to ice tons of the abashed EPAAUuroxledgmant of Consent <br />I rsnby Nat me snare medmdraton steamers idenbOod 40 CFR 26227(a) (if I am a targe quanmy yonsmum)j or (b) (d I am a snst quantity gorses od is tre, <br />Gen <br />'� <br />din <br />s tin S am0 ' l 4" B gra re <br />r r o� an ►e ask Idt q I <br />= l <br />16. Inlemadgw Shaamen <br />❑Irrynrtm U.S. ❑Ex}crfmm tl.S. Poria entrjMxd' <br />Tranaoarfer stundone for exparts on : Date tomo U'S'. <br />w <br />17. Transporter Acyl oWadgmeM of Radars of Materials <br />ryp�Narte <br />y <br />K <br />Qx <br />i' nsporto Prin ypetl Name Iqnmum Martin uay year <br />K <br />r— <br />18. Discrepancy <br />lea. Discreparty, Indadrian Space [ r, <br />Dzangty, ❑type ❑Residue ❑Pineal Rejac6on Rejarxgrr <br />uFuO <br />kt&ii�st Nelarence Number. <br />78L. Atemate fiac&tq(orGenwatorl US EPA 10 Number <br />J <br />U <br />Q <br />a- <br />w <br />faaFt's Plane: <br />ills. SignalureaPltemak Fadity(ar Constraint) <br />Momh Day Year <br />Q <br />x <br />V5 <br />19. Hazafdous Ytab'd Report Monagemyo t Memod Codes 0,e., codes RrhaZadous wash treatfr ent, (fisposo, and re s toms <br />�m9 Ys ) <br />p <br />i <br />2 3 <br />4 <br />20- Desigrabd Fad"uy QK»;r ar OperatorrN'aaaon CeOf receipt d hs smous materials severed by me mardest ex:apt as naled in Item 18a <br />tin Spud ame S"Tava, mq,0 Day year <br />CDA <br />c....,, 6,0 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />