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0 0 <br /> Please print a type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t-Glen`eralar,ID Number 2Pagelof 3.Elrergerlry Response Phone 4.Mani Tracking Number G �( <br /> WASTE MANIFEST 4 /;;;:rr� ,tin-n, ^.C r p .. "j 5 JJK <br /> S.G¢t,"b Name t_Y.RAo¢'_'I IKI � r�. Gemrabls Site Atldess(ddmerent than mi address) <br /> PJf•� l .rr.Jt fidT'r.- .i�C! <br /> 2%;k4;iV i T;•_R AA <br /> .-.b >„(t,{ r"!<i 'R' •;;tint <br /> Generator's Pmone' ii'q i=�_C•_:r i t! - •:f . <br /> 8.Transputer t Company Name U.S.EPA IO Number <br /> 0.�L�+_FTYf-NILtHi'•fd3vlrF•I'�: }.-}i=.Y)r-7�`-t <br /> 7.Transpaer 2 Company Name U.S.EPA ID Number <br /> e.Deelp%3FW9m11 <br /> � U.S.EPA ID Number <br /> Iq)00P40RTFiAlAkERA 1r h:1 <br /> Cf A PTON � <br /> Facw sphone: tl 1r)111,f/-i i(*) ?' •) b ii ri i i J <br /> ga• W.U.S.DOT Deealptlon(Yloaep Proper SNppbp Name,Huard Class.ID Number, 10.Contaileta 11.Total 12.Unit 13.Woo Codes <br /> HMP 'Ap(de^/)) NO. Type Quantity WLVd. <br /> 1. <br /> o 1,144-R.CRAH0ZAi ii t 1,;`-r.aC'j(,IUVtAIEt - <br /> z 2. <br /> w <br /> c� <br /> 14.Special Naming InsWmms and Additional Inlon btu <br /> WRE „ "B} Ir,I ,pltni:i!E9,-?.'t r:!!.'TWAT[r; '?FPi{i.o3FilATEPEkSr�NALi�i.tilt.t;TIuEEQLNh+i4Eigli <br /> 8B(Paojde_tf60469Al2 POBAA80103345 <br /> 15. GENERATORStOFFEROR'S CERTIFICATION:I hereby declare mal tie contents of this constgnmenl ae/uly and accunlely described above by the pupa slvppng name,and aredassifee,parYzged, <br /> marked and abefed'ptacai and are:n an respects in proper cordibon for transport wovdbg m applkade imemationand nabonal t ovammenta regulations.if export sNpinni and I am t e Primary <br /> Fapokr I certify,fruit the contents of Na consgnnenl cort3xm to Unit tame oftie aladed EPAAdno ledgment ofConsent. <br /> I tally that the waste mwurnaatpn statement identified in 40 CFR 28227(a)CRI am a Inge Quantity generator)or(b)(dl am a smel quantity Franatorl is vue. <br /> Geerear's/Olemr's PMkNfyped Name Signature Muth DaY_ Year <br /> 18.Inteaborel SNpmen¢ <br /> _—1m <br /> ❑import taus. ❑ElpcA from U.S. Pod densy,'edt <br /> Transporter signature(for exports oni Dao kamg U S.: <br /> ti.Transponer AckroMedgment of Receipt of Matedas <br /> OTransporter 1 PrinteclTyped Name Signature Month Day Year <br /> 26 TranspMer 2 Pmtedfyped Name Signature Month Day Year <br /> K <br /> r <br /> i18.Discrepi <br /> 188.Discrepancy Indication Space ❑ Duanuy ❑Type J Residue ❑Partial Refection ❑Ful R.". <br /> Mandest Reference Number. <br /> 18b.Alanate Facility for Generator) U.S.EPAID Number <br /> J <br /> U <br /> tai Fadays phone' <br /> W 18c.Sgnalaeof Alienate Facky(or Generator) Month Day Year <br /> a <br /> z <br /> N19.Hazardous WaUe Report Management Method Codes Cie..codes fa hazardous waste sentiment disposed,and nacyclin9 sysltei <br /> 4. <br /> 20,Deepreted Facti Onnar or Operator Certification of receipt of hazardous matenab covered by the mandrin except as noted in nem 18a <br /> 1 Pm Yped Nana Somali Month Year <br /> EPA Form 8700-2.2(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />