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i. Please rent or type. Form designed for use on able 12• Itch t vlNler. _ Form P P 9 ( P ) YP ) Approved.OMB No.2050-0439 <br /> t)NIFORh1I1A1ARDDUS 1•GcneratoriQNumber �'��" 2.Pagelof 3.Emergency Response Phone 4.6Sani{eslTractingtfumber ` <br /> WASTE r- �.� c Q3:��c y � c� . ►0 7r 1 Md 009812053 JJK <br /> S.Generatod MANIFEST <br /> end Iactin Addres 11�J151U7enereto. Sits7( drytthan ma <br /> pgaddress)Jr'ckii � fiETRo uTnni <br /> Alf;PoR7- <br /> ,' Ot)o I-1 Willi/f <br /> 5Y17{�, <br /> Generotor'SPhone: vr�d[L ') u �r," 1 "S____ 7:rL`:-.20- •' i <br /> 6.Transporter 1 Company Name U.S:EPAM Number J <br /> NRS. Stay-,i Icp S C K 30 L <br /> 7.Transporter any Name g' U.S.EPA 10 Number <br /> I 16�-7 <br /> 8.Designated Facifty flame `+d Site Iddress LU.S.EPA ID Number <br /> c'r sb � <br /> st <br /> FacitiVs`66 Phon o�' �" OIC a CAD (9 -' 0 P <br /> i <br /> ga• 9b.U.S.DDT Dascription(Mudng Proper Sh'ppng Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit i <br /> UI&I and Paddng Group(f any)) No, Type Quantity WtNol, 13,Waste Codes <br /> 0o t Ovi-Z5A liazG,s�&wt biers -e,Lvi 1r£i� 33�--- <br /> Oil— Dfy) <br /> r2 2' <br /> ODtA'- fes' + RA71u-d0wsWktS�-e <br /> Cie iji i 5 , "�rtt to I�� t ri rlat>�,y od 1 b M 0,100 <br /> 3. <br /> 4, <br /> 14-9pittal HandlingaVucLons a Noe'€Informs <br /> pec <br /> OR CES l b0� Ry p <br /> 9 91 16 j 1 g r-L 57 I� i K5 - <br /> 15. GENERA7OMOFFEROR'S CERTIFICATION I hereby dedare that the contents of lh1-s consignment are fuly nd accurately descrrGed above by the proper srG>ppirq name,and are classified,packaged, <br /> marked and labeltdlplacarded,and are M 0 respects In proper condition for Uanspoit acowding taappticabte Intematronal and national governmental regulations.If export shl"ril and 1 am the Primary <br /> Exporter,I certify that the contents of this oms!gnmont conform to the-turns;of the attached EPAAekno fedgmenlof Consent. <br /> I cerrfy that the waste minlmtzation statement identified in40 CFR 262:27(a)(f I am a large quan9ty g ratotrdt(D)(din emelt quantitygenerala) true.42 <br /> Generatols/ sPdntedlfypedNa Signals f,[an#h Day Year , <br /> I3 i <br /> a9 �7- -,17- - cf%'-clic`-— J;.�/ r.�K <br /> 16.International Shipments ❑Import to U'S. Li Exp from U.S. Port of en la)dt: <br /> i Transpoder slgnature(for expotts only): Date leaving U.S.:, <br /> 17.Trimpodt rAclmar,edgmenlor Receipt of h4aterials <br /> t Transporter 1 I'MedlTyped Noma S!gnatum f 4anth. Day Year <br /> .�u . J 4 3011-3 <br /> Trensporler2 PrinteM ped flame Signalure Month Day Year <br /> E� <br /> E ~ <br /> 16.Dlsaepancy <br /> 1 Be.Discrepancy Indication Space El Quant iy ❑Type ❑Residue ❑Parini Rejection E]Full Rejection <br /> Manifest Reference Number. <br /> 46b.AfiemateFaaTity(arGenerator) <br /> U,S.EPA ID(lumber <br /> U <br /> u� FaalilysPhone: <br /> w 1&S. naluraofAitemateFacility(or Generator) fJonth Day Year <br /> F-- <br /> 14 z <br /> 1g.Hazardous Waste Report fdanagewrit 14ethod Cades(.e.,codes for hazardous 5vaste treatment,dtsposz%and recycling systems) <br /> 2 <br /> 26.Doslgnaled Facl ty C rotaer or Operator.Certification of receipt of hazardous mated is coveted by the manifest except as meted N[tem 16a <br /> f th Y <br /> e t <br /> PrintedlT ed Name S�naturo i <br /> EPA Form 8700-22(Rev.3.0 Previouseditiionsareobsole.. - DESIGNATED FACILITY TODIHSTIN1ATIONSTATE(IFREQUIRED) 1 <br /> E <br />