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Please print or toe.(Forth dell ned for use on elite(12-pi1ch • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID hkmnber 2.Pager 1 o7f3.Emergency Rem Phone 4.Manrestt cidnNumber <br /> WASTE MANIFEST C 4 a 3 1 (8hi 424- O 1063 c p JJK <br /> 5.Gerieratoes Name and Melia Address Ganaretlrs StteAddiass(adi fereni mailing address) <br /> 0i?YQ STCM.KTM <br /> 425 N. LL Fk)RAi Ni.'e Tie1 4tf5 i W. 'Ill.AVE <br /> sT':X;'hTCii Cr"t C A (4M <br /> tx <br /> Ganera 'a Phone: Fid?2JiF, :N:14 e <br /> 8.Transporter 1 Conoaro Neme U.S.FPA ID Number <br /> R�Cilll)R> N4"luN91FPJf'A..SF✓;+e1Ja;; C ? U 0 2 6 rZ 'i 7 0 5 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name And She Address U.S.FPA ID Ni <br /> t�dr�NJ`�tur r'?�ll�i�r;>(:dri <br /> '?kiUO P2C,d'!Thl,hi., CJ:ti:;Ftt£�r <br /> Fadi Phone: i;4ti1)F±T.Yu'M} <br /> As, 9b.U.S.DOT Dmsvipapn(inducing Proper Shipping Now,Hazard Gem,W Number, 10.Containers 11.Total 12.Unit 1$.Waste Coda <br /> HM and Paddng Group(d any)) No. Type Quantity WWd. <br /> 1. <br /> N!:Ric,I'.f?AHns'I+Jt.fiCL aUi;.Ik4li{s}tI,Y!ki <br /> z 2. <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14.9pacisl Handang Inawctiprs andAdddad IMamabon <br /> "�1i ',]gi17f 'W'{!r-1 ,:#'.K'.t . _....,..,... .,.'?II.YWA!'*LR'A,Io'? iitA�!,i MRIOCN&PROTEOTIVEEOl.NE7WNI <br /> HT FR0JTZCT# 60241Al2 P0#080102167 <br /> ''5. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the oonienb of this consgunerd aro fuiy cord accumtety described above by the Proper shipping nai and are classified,pacii <br /> marked and labeled/placarded,and ere in all respew In proper condition for"Mat according to Applicable international and nai govermrental regulations.ReVnd shipment and I am the Primary <br /> Fxporter,I catty than the contents or Nh:consignment conform to the two of the attached EPAAcknoWedgmant of Consent <br /> I certify that the Waste humanization stetamerm identified In 40 CFR 282.27(a)(d I am a large quantity generator)or(b)(if I am a small quan8ly generator)is We. <br /> Ge merslOtari PdntetMyped Name ,signature Month Day Year <br /> J la:mmintonal Shipman` l <br /> � ❑Irtgrorlto U.S. ❑Export aan'11.8. Port of entrylads <br /> Transporter siplature(forexpods onfy): Data lea ft U.S.: <br /> w 17.Transports,*Acknowledgment of Receipt of Materials <br /> [r Transporter 1 Pricutryped Name SituraNaa-" Monro Day Year <br /> ..., .4 ' <br /> GTranspoder-2Phi Name.. SIl818Nre -� MorM Day Year <br /> t- <br /> 18.Discrepancy l <br /> 189.Darmouncy Indication Space ❑ Quandry �]Type ❑Road. ❑Peroral Rgxdm ❑ ull Reieobn <br /> Manitasl Refers ce Number: <br /> 18b.Aaemate Fedity(or Gererela) U.S,EPAID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Sitrawm ofAltamela Facility R Ganemw Month Day Yaw <br /> a <br /> z <br /> 19.Hazardous Waste Rapat Management Method Codes(I.A.,codes for hazer w waste Muni depmed,and recycling systema) <br /> 4. <br /> 20,Designated Facility Owner or Operaml.Co0cation of rkW of thewdous matedals covered by aw manifest accept out noted in Item 180 <br /> PMteNtyped Name SgnaWre Monro Day Yea <br /> EPA Forom870D-2Z(Rev.305) Previous editions are obschiii GENERA M'S INITIAL COPY <br />