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PW-i .prim[dr lyhe.(I aim dma19flad for d,W i oi)olfle(12-1)iIch)typnvrriler:) Foam Appikiticd.()kill No.20,50,0039 <br /> `()RM I1A A C)()tJS t nrr lar I)Nunoh r 2 f 3du C of 3 Ltrcr�r€ic,J fi pc r Pha <br /> tm <br /> f ft of t Tr cf h5g tfunther <br /> ".)ASTC,rsiANlFUBi' 7 5 <br /> b.Gene€ale€'s Name and Pha€Iii€tj Address t3enorat&s Sila Address(if dilfoienl Ihun mal€l€€g address) <br /> El- ,(' fiti1A`feftt,r I 0 `°1A iNt; - <br /> MINN <br /> GensralarsFhore: 210 1 81,1!i-"11,1 ! <br /> G.Tiansporlst t Cor mpany flame U.S.EPA ID Number <br /> V1110 RLD 0'),EMVfIR, l€''Ali fTf 1 `tP,V11f � �i ?$1 0 2 . 1 T l! €+ � <br /> 7.T€ansparfar 2.Gampar,y Nance `- --— U.S.EPA It)Number <br /> 0.Des Paled Facility Marne and SIN Address U.S,EPA iD N€unbur . <br /> Lf)i r+ Il l' <br /> QIA 2 Z2 <br /> Facilft s Phnne: [s i, <br /> y IEtsSr-, €pry _ 4 �: <br /> -�.--�•-x.®- _ � 11.Total 12:. <br /> ga. _9b:US:DOT De cription{Including Hope[shipping Natn,Hazard Class,ID Nuaiher, 10.Cuntalneas tlnii <br /> HM and Packing Group(if any)) No, Type 0ua0ty WOW. 13,Vvasin Cods <br /> a <br /> I` <br /> 14:Special Handling Instruclicins and Additional fnfannatron <br /> Chit'R�:��NOY00KITAO ,011rN`Y131Y C 1-SO 1-424-g3CO0 t OEERMINAL;0CRES Ce N A L2 R 0 f2R1;JM1 V10 FILE ,.9B F <br /> 4233W�ASOLIN LE,UESEL'; APPROPRUE PERSONAL PROTECTIVE C Cil IRAE N <br /> 15: GENERATOWSfOFFEROR-SCERI]FICATION:I hereby declare that the contents of thia consfgtment are Mly an4 accurately described above by the ptoper shipping riama,and are clasollied.padriged, <br /> maiked and fabaledlpiacaided,anil ars In all€especis kr proper condition Cat transport a=rcl rN 10 applicalile Internalionaland ua6rial g mn?d1>. regulations,Itexpod shipment and I am the Plenary <br /> Exporter,I certify that the cantonis of this consignment conform to the terms of the attached MAcknowledgment of Consent. <br /> I seikfy that the was3e mirdmf'auorf statement identified in q0 CFI{262.21(a)(i(lama large quarrkly genorator)or bj}itlra a small gta€5G[y ganet�lor s true,. <br /> e 'ralnrslC}ffrArs'Prnladffypa Name fgn tlit�" - Month.. _ Day Year. <br /> a 1E:lrftamagonatShf�!e t <br /> p Eli Import to tJ.s. ❑Export from U.S, r�Ort en[glerdi: <br /> 7rassporleC signaler©(for exporls only): 1/Odlo leaving U.S.: <br /> 1I.Trans porter Acknoy.fedgment of ftefptof hiatedats ' <br /> Tran(fojl r1 P€In1 ciffypej Name r. Signa[ure (1/1.` Month Day' YeariV� ' _ � C7 / fry' <br /> Transpwter2Plnladffyked'Name <br /> Slgnalwo � Month Day Yen, <br /> 18.Discrepancy J <br /> Ida.Discrepancy lndlca(lon Space ❑Typ a <br /> ❑Quant ry ❑Residue ❑Partial Rajeetion ❑Full Rejection k <br /> Manifest Reference Number: <br /> :TgWllertlaW Fasilily'(or Gonentor) U.S.EPA ID Number <br /> d - <br /> V - <br /> u- Faffity'sPhcno: <br /> Lu 180.Slgnaturo otAltamate Facility(or Ganefa[or} Month- (lay Year <br /> 19, azardous Niasla Report Management Method Cedes ji,o,,codes for hazardous waste treatment,dlsposal,,and rpeycfirrg systems) ' <br /> � hazI <br /> 2. 3: 4. <br /> t <br /> 20 Designated Facility Owner or Operator:C01ricallan of recei y, f hazardous materials covered by the manifest except-a n*d lnjtetjaa <br /> Pri'teffypsd Name J Signalure Mont flay Year <br /> �PAFo1rn=0-22(ReVA-05) Previousedillimsare obsolete, pF5i'G1q14T D'&C L'IT TO GENERATOR STATE(IF REQUIRE) <br />