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t <br /> Please pdrit or fype.(Farm des{ ned for use oq elite 12-pitch)tyBWrlter.) Form Approved.Oh18 No.2050-0039 <br /> 1.Generator ID Number 2,Pega 101 3.Einergancy Response Phone 4.Manliest Tracking Number <br /> uNtFORI,i,ffAZARoous I r I_ { :: f 0 J J K <br /> WASTE MMfIFEST i� :� )3 1 :; (` `'' !t r cy %is ii (. <br /> 5.genera}qf s fame and Mafing l�ddr Generatols Site Address(if ddferent then mating address) <br /> ?Y ., n�,tw r"• L;> r i'l sz•"1ST iJ:r f.U. +`+Y J,7' .fita;:fti C,.C_ L S{1 !-,j rr - <br /> GeneratorsPhana: <br /> t3.Transporter 1 Company Name U.S.l3AID Number <br /> 101il J.P '1T':U1: '101i)+.1ntk-,J.=_i! 3C-tvv.$r. <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name ,q x 1 <br /> 8.Daabnoted Facility Name and Ssste Addre >;U.S.EPA ID Number' <br /> f.: 313:r1J� ti� �kii`[13C+1Sfli;;� , ?.i.f� <br /> 3S'451 f7LD '-5KY,'V.WF. 7t070L <br /> KWI."S]:rT�-i-1Rif CA, <br /> FadWs Phone: - I <br /> ga, go.U.S.DOT Description(ndud'u}g Proper Shipping Name,Hazard Class,ID Nombar, 10.Containers it.Total 12.Unit 13.Wasle Codes <br /> HM and Packing Group(+f any)) No. Type Quantity WtNol. <br /> 1.1a;aT.r c�. tittll3)b3.'. fSr:'jsC; , <br /> 4 v <br /> �'!_itl})r.t.tit L.-1-1 <br /> �.. .,t,]- �} <br /> ( !LU <br /> lJ <br /> w 2 T10"i 'VC:R-A RA7,";let)1-*WL1 r"1'Awi'i-;' :iaw:ri 1�11:I.Xr/I:t Ff:l: i <br /> 111:'.f 17 1i,T,t,r 'l';a' <br /> 3. <br /> 4. <br /> 14.Spedal.Hand_lin Ins"ctions and Additrtional lnrormavon . <br /> :tS�1Cf(i,}1fJlrr; 'tt�f_s.i.��,�i_; ;"r Cirl7a3,{il: I�r-C''< <br /> Fk- fi_.l t w2'7,•:z; <br /> 15. GENERATOR'SMFFEROR'S CERTIFICATION:I hereby dedare that the contents of ft vonslgnment are fully and accurately desmhed above by the prdpershipping name,and are ckas9itied,packaged, <br /> marked and labeledfplawrded,and are in at respects In proper condition fortrarisport according fo appN;able International and national governmental regulatkm.If export shipment and I am the Primary <br /> Exporler,I teddy that the oontanis of this consignment conform to the terms of the aftched EPAAdknoviadgment of Consenl. <br /> I certify thet the waste r nimaaton statement Identified In 4b CFR 262.21(a)(d I am a large quantity generator}or(b)(11 am a amafl quantity generator]rstn e. <br /> Gswratars101fotor's Pdnte&Typed Name Signature Month Day Year <br /> hil <br /> 1 I$.Inlemalonal Shipments <br /> r-- ❑Import to U.S. ❑Export from U.S. Port of t 6t: <br /> z Transporter s!gnaWra(for exports only): Dale feaving U.S,: <br /> w 17.TranspoiterAdaWedgment of Receipt of Materials <br /> Month Day Year <br /> 12 TAprer t PdnteMypad Name y p <br /> Transporter 2 Printedflyped Name Vgnature Month., Day Year <br /> 1 <br /> 19.Dlstrspancy <br /> 18e.Dlsaepancy Indication Space ❑ Quantitty ❑Typo ❑Redd.. ❑Par4al Rejection ❑Full RelecC. <br /> Manifest Refamift Number.: <br /> lob.Alternate Fadtity(a Generator) y F (' . i 1 'U.S.EPA ID Number <br /> "IU Fac&ly's Phan <br /> 13 loc.Signature ofAltemate FaalRy(or Generator) Month Day Year <br /> 19.Hazardous Waate Repot Management Method Codes g.a.,codes for hazardous waste beabnent,disposal,and recyding systems) <br /> C 2. r <br /> . <br /> _'�\4 fir <br /> 20.Das' led Faa ity ovnerar Operator.Cerh6cabDn of recelptof hazardous materials covered by the manifests ceptas noted In Item t8a <br /> S ......... Wgth Day Year <br /> P.do Yp N \t F r9 << t5� "� <br /> EPA Fomn8700-2 (Reu3-05) Pre0ouseditions are obsolete. DESIGNATED PAC)I»ITYTOGENERATOR <br />