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Plisas rentor a FQt7�t desl ned for tasaAn elite. 12 pitchFortto—k rov d . 4 Q 2.Q$0 OQ35 <br />1 GenerstorIDNumb er2 Page1'of 3 fnergencyResponsePhone 4 a 8e j <br />54b �2 263 <br />5 l3eneratots arrte`and ailing Address .. enerator's Site ddwss (if d rent than inalling•adtlreae) <br />GeneratoieRhone:. x#00 ;►'45-22.63 <br />Transporter Company. Name U.S EP IDNumber <br />7. Transporter 2 Company Ne U,.S EPA IQ Number <br />Name <br />S f RV.dy Rl 65 <br />Fattiilt. s Phone.3 3616 <br />i <br />ga 19b. U.S. DOTPescripdon (including Proper Shipping Name; Hazard Class;ID' Number, le;ConFe!ners . 11; Total ` 12'. Unit 13: Waste Godes <br />HM and Packing Group (if any)) No.. Type . Quantity WW61 <br />I. Ron n y4°X,c97 471Ja 1da�s* a151.:1:4 5.',t. ' i6a�Ei� <br />tri:X.tas <br />10 <br />2 <br />P,,,,,, E; k; <br />ar <br />3, <br />OCT�� , <br />a <br />y , rw Twer- IT <br />14. S ecial Handling'Instructions and Additional Information <br />1. ui..7_y :s9, grj.A j� esc�i.::s cdJ�. �r�1�. 0526—Ml <br />tft •a .t)ei ptaot�r<ieq, ang r@lea �'psp. rY, I�Q.. 4 .s _ .;,.:„..; ' t@lYi a6 'e �I�.jp.:y,.Botvei�ertl_a•.h <br />•15. GENERh nareilyadaclarbed bbt pfft..lilo��s�r.�shlpI p,ain�gn� n��a�a, •re1� kbit parajyed <br />ifel by decliiePnma <br />_.- sy <br />Ct�ig i�iifgpi(' is C` �8'i1fo��p erm e a ac e c o gmen o ns , <br />Ir'rr'r y that the waste minimi. lon statement identified In 40L CFR 262.27(a) (If I am a large quantity generatcr) or (b) (if I am mel) quant) senerator) is true. <br />Generator's ecor«s'Printd ype Name igna re on ay ear <br />16. Internafional $ht ” ents <br />F- Import to U:S. Export from.U.S Port ofentry/exit: <br />z 'Trans oder i natureforex o 's..on! : LDate'leavi �t r <br />w 17. Transporter ASWftringht of Rece! t of Materials .,®r <br />Si <br />0: Transporter 1 me ed`N e r� pyy 9nalufe f %,' °Fl Day rTe a <br />Q. Transporter rinte' ed Name ignature "'monthay Year <br />F- <br />18 DlsctapanoY t,;1 <br />18a. Disi rapaney Indication Space ❑Quantity E]Types Residue ❑ Partial Rejection [D Full Rejection <br />ManifedReferencs Number: <br />18b:—Alternate Facilrry (or Generator) U.S. EPA ID Number <br />=t1�at�n ,Jrt�Uf7C-'4 '` -un. ';h 7u .1 v!`�!" Ste ,A S �;. C, ! !�,:Vn� 1 _,.: i>K f�""kiq;�..,bb �sv��t... • � ,., it+.'e�. - <br />186. Signature of Alt'emate Facility (or Generator) Month Day Yeat <br />z , <br />19. Ha2erdbtralyt/aste Repott M` aemetit:'fgsthod Codes (i e.,codea for hazardous�waste,treatment-!isposatr end;recyclingsystems) <br />1 2. / <br />20 Design ed= acility 0wner:yle <br />or. Qp rator Cer98Ca reseipf of'Hazardous.materiais covered by3he>manif . t except as oted�n m <br />na u .: <br />Printed pW., hie' - St t re � ay ' <br />`.- r_ <br />EPA Form 8700 22ev, 3 05) Previous editions are obsolete. ` - DESIGNATED FACILITY TO GENERATOR <br />