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Please print or type.(Form designed for use on elite(12-pitch)ty everiter.) , '`•� t} .( ?t�\�:J''y �..•• Form Approved.OMB No.20500039
<br /> UNIFORM HAZARDOUS 1•Genoralor ID Number 4,Manifest Tracking Numbed
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<br /> 6.Genarelor s Name and Mailing Address Generator's Site Address(!f different than mal'ing address)
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<br /> 6.Traa�rVater 1 Com Name U.S.EPA ID Number
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<br /> 7.Transpo or 2 Company Noma
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<br /> 8.Designated FacUdy Name and Site Address U.S.EPA ID Number
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<br /> 98. tib.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Conlalnars 11,Total 12.Urlt
<br /> HM and Pecking Group(if any)) No. Type Quantity WtNoi 13,Waste Codes
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<br /> MAR 2 0 2015
<br /> 4. CRA INC.
<br /> INDIANAPOLIS
<br /> 1 .Special Ha—
<br /> ndling InstwOons and Addlllonal Information
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<br /> 1' 15. GENERATOR'S!OFFEROR'S CERTIFICATION:I hereby dads re that the conlenls of this consigamenl are fu ly and accurately describrld above by the propurshipping name,and are classified,packaged,"
<br /> !! marked and latieledlplecaided,and are'Inell respects f pro'percondition(or lraReport-according to applicable nlernallonaland national govommenlal reguta0orisi It axpod shipntanl and I em'the P mary.
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<br /> t•. >xpoder,I d0djfy.1hal The contents of lhls donslgiumehl conform to the terms of the al(achad EPAAcknamedgmeflt of Consent.
<br /> 1.' I cer(ify(hal No vrasle mimmlzagon Slalemenf ideng�ed Infill CFR 282.27(x)jif I am a large quantity gerierelgr)or(b)(If)�am a sfnalf ghan0ty generator)Is Jme.
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<br /> 16.International Shlpiaenls �Ex i
<br /> p.. Impart 10 U.S, pot from U.S, Pod of on4loxk;
<br /> Z Trans rterslgnaluro(for exports ordy): Dale leaving U.S,:
<br /> Rj ITTranspoderAcknowtedgmentofRacelplofMaterials
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<br /> 18.Discrepriay
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<br /> Manifest Reference Number;
<br /> 18b,Allemate Facility(of Generator) U.S.EPA 10 Numbs r
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<br /> LL Fadlity's Phone:
<br /> w 18c.SIgnalureolAllernaleFactllty(orGenaralor) Month Day Year
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<br /> N19.Hazardous Waste Report thanagemenl Method Codes(.e„codes for hazardous waste Uoatmeni,disposal,and recycling system s)
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<br /> F 20,Designated Facility Ovmer or Operator,Cerijocation of receipt of hazardous materials covered by lie mantlest except as qcted In
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<br /> EPA Form 8700.22(Rev.3-05} Navio�geditions are obsolete, �SIi�®F ACID ITY�O GENERATOR
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