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Please print or type.(Farm designed for use on elite(12-pitch)typewriter) Form Approved. DMI I No.2050-0039 <br /> UNIFORM HA EARDOU5 1 1.Gerrereur ID Number 1.Pape 1 of 3.well"I$eepgytvr porye:�.,;!?? � Net Tpcggg�ury�Br„ � <br /> I iYiAx 4 924- td,ti.} � . FLE <br /> WASTE MANIFEST - <br /> 5. eralors Nam end ;Amp Add a Generators to cess rare then meting address) <br /> 2® �cJ2�f0 <br /> Gerterelore Phone: e <br /> rensppwr parry erne U.S.EPAID Nu ider <br /> :+t:.514it: <br /> 7, mnspnwr2Cdnpeny Nems US.EPA IO Number <br /> qui a"I'69'If ll` `.it'•e.:iv'k}I4" W:AB.}f' Sala7I Is1L5, IFae NPd�1iia)itaSJ7I <br /> 1 naw a eena U.S.EPA ID Number <br /> (At^e,w Itifllot 'n hilt/ .ttitirt. €:I° <br /> 1021 Iger.rvira+su Ittind <br /> ;>an rove, ('A ""I i 1 ; <br /> Fedi Plum: itllit)441-.0^0:.! C^LN15'1}+f.l3lt) <br /> ga. 9b.U.S.DOT Description(mdudng Proper Shipping Name,Harald Close.ID Number, le,emusfers 11.Total 12.Una 13.V bid Codes <br /> HM end Pecking Group(dany)) No. Type Quantity MAka. <br /> 1• tltdtal4ity W>x;ti^ .It}a1ANzsfsk: lifitkids. all •Y.ii, r 34.1 <br /> (tAifi}.ri3ti;s F.t1sowit eteld i-irw"Ir}Ilelivade,i ,11 <br /> 4. <br /> Ipi-t } tr IRk!1 <br /> W ( 1!`#b+f1 WretiLt: ('carrteyiau lis{vA t i. y4 <br /> u N (f.'4Hid.a4Tyt,; (: mitaiAe: '.acid tux} S11IfurrvI: 16th01, t:e <br /> "I.- <br /> 3'Sfk,ato-'K='{eel }l;x•r.avlkw+. tali+vie: t.iquis `4,. <br /> (tltutaratyiehydFay e: <br /> 4, skin-Pl'l Illtt..$xdr;w; Ojg>J.IL I itJOA toi l calitI 1.71 <br /> Wtt},s:i 1 <br /> 14.Special handillig ImIriceonc and Additional Information <br /> I:U}l]:>5!M3 <br /> (11.IS14t efit 4-oil <br /> 15. GENERATOWSIO 'S CERTIFICATION: I hereby decree tut the cantons of this comignmxdare futyand accurately our ed soon by the proper shipping name,are erem .*Bitpackaged, <br /> marked and labewdpNlaoded,and are in all respect;in proper conmtlon for transport according to applicable Inwmadonal and redo fit governmental regulations.It export shipment and I a thprimary <br /> Exporter,I certify that the contents of this consignment mnfonn to me terms of the attached EPAAcknowfedgment of Consent. <br /> 1 aellfy that the wsale mlNmbation ewwmerd idenusd m 40 CFA 162.27(e)(I I am a large Wenlily,generator)2g)(it I am a small quantity Weratior)is no <br /> Gewam?§iOffw&ss reruft Day Y, <br /> .Intematonal Shipments <br /> P— ❑Import to U.S. ❑Export from U. Pon of nli Mit <br /> ? Tions rtam for Date las' U.S.: <br /> 17.Transporter Acknowledgment of Recalls of Materials <br /> ren.$ 1 Printedrry B N 0 re ay oar <br /> 6 r ' <br /> ZTrarillil 2 Prinled/Typed Name Signature tz my Wari 15.Discrepancy <br /> has.Discrepancy Indication Space ❑Cuantly ❑Typa ❑Residue ❑Partial Rated. At I Rejection <br /> Mandeet Reference umber: <br /> 18b.Nwmea,Feollty(or Dermot) US.EPA ID Number <br /> U <br /> LLFadf sPhone: <br /> Bc.SlgneumcfAtemete FadDy(or Geruraur) Day Year <br /> Q <br /> Z <br /> 19.Hazardas Waste Report Management Method Codes lie.,codes Nr he;ardcus weave heaonmt deposal,and recycling systems) <br /> 1. 2, 3. 6. <br /> 20,Designated Facility Chimer or Operator.Cereficaton of redoubt of hazardous mahmals covered by the mantest except as noted in Aim le <br /> pointe yped Name Slgnetue Moro, Day Year <br /> i <br /> 00.22(Rev.3-05) Previous editions are obsolete. GENERATOR'S I (TIAL COPY <br />