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,>! Sr,.iFt 'q. 6@7,.3 1111111111I�II�IIIIII�I'IIIIIIII <br /> 0 0 5 3 2 8 9 7 2 5 K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number rh{)^jr��` t r>`r,�; 2.Pagel of 3.1Emergency.Respo}se Phorte 4.Manifest Track* Nber <br /> WASTE MANIFEST t 1005328UM972 SKS <br /> 5.(jaerators Name and,Mailing Address Generator's Site Address(if different than mailing address) <br /> wd <br /> Tit,( <br /> Generator's Phone: <br /> 6.Trin'sp6P- T"iCompa"y Me SYSTEMS 7 htf- U.S.EPA ID Number <br /> Y MAR 0 3 2016 rLr .Sf�l�!:!�?j <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> ENVIRONMENTA <br /> T <br /> 8.Designated Facility Name and Site Address i.;i..i::f{{•N H•4i�.iiC�!4 �; ::f!N'/ w;`:i1:: !. .. U.S.EPA ID Number <br /> Nli <br /> N J1 05 <br /> Facility's Phone: <br /> 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit <br /> HM <br /> and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> Z _ ,._._.ya•.� tea,.,.._. ..-,..,.... .. ,i.. <br /> LLJ <br /> Ut• <br /> 3. 1N1r:1 rr%1.0 I V. a.. I t-E.„t_,L__H I Ell ht l�t-;.J t'.:�"� <br /> WITH 011-iy 14/A 7 V� <br /> 4, <br /> 14.Special Handling Instructions and Additional Information ' <br /> L'IL 11r LI!C. LIf r''. 1, �r- ' 1�00_.411-.-8_..F760 t"EK it TF...I..I <br /> ! tt 7-+, ,_ r' as lr t T N ! }:: Ir+ D StJP CARR TERS C• S \ -"i' Y <br /> �I:jTr: ��,, 1,.:,_; Vit R, B, 1 (`1 Tt:: R fit !__I�.i,•�Et> ,., �b F.t.I �2.� fi:� sIEGf i:r stt.'; <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable internati nal and ZZ <br /> tal regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowled nsent. <br /> I certi that the waste minimizat' n statement identified irf'40 CFR 262.27(a)(if 1 am a large quantity ge ator)o (if I am arator)is true. <br /> Gener it Ver 's Pnnt6d/T pe ' e Sign Mo Day Year <br /> J 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> go 17.Transporter Acknowledgment of Receipt of Materials <br /> UJ <br /> IX Trans er PrintedlTyped Na Signature Month Day Year <br /> CL U Ls <br /> z Tran orter 2 Printed/Typed Name Signature Month Day Year <br /> Q <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> CAI <br /> 0 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPpp. arrtt81002 Re.:3-05)pfevious dltiorts�ar�•o sofe�e t ,•. ) -:�F 1. NATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1'.�! !4•cr,,_ �r �:� lr 1C�c'!t! t� � _ - <br />