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Please pinta .(Form (a use on elite(120tch),r„a•Nrlter.) Fpm <br /> UNIFORM HAZARDOUS 1.GmW11IDr 10 NW*K 2 Page I of 3 Emergency Response Phone A. nlMt TrK"Maybe,�.OMB No.2050-0039 <br /> WASTE MANIFEST .(; 1 1 I t r s, ;°S `, Q;, ^ J v U <br /> FLE <br /> 0.WMVWS NO*and able chi san maibg address) <br /> i',ary �fr.a1UC.T3 NK. <br /> ,{oa! r1tXKtlldl d1M <br /> Gereralers Plan: . JV32-6. B.K) <br /> Nnspals U.S.EPA 0 Narlber <br /> '4'aub.,..A)ClOWI4.e11 fnMv{xRl hG. tG4) ,:;y -t;rNiUJ�['rp(, <br /> 7.Transporter 2 C4ffWW Name U.S.EPA ID Number <br /> 8.Oesipated Name U.S.EPA ID Nunes <br /> 1'. sxx.:9l t,c,ad TF altrinwit <br /> �t rJlh fltvtl 1w NMI'Sf1fl2'IOt�i}7 <br /> eltvtx+9ra>m. W 01O7 <br /> F a <br /> 9, 911.U.S.00T DuoipYat prJu- Plops ShygYp Nemo.llaard Cd*as.0 Nurlber. 10.Contemera 11.TOW 12.UM 13.Waste Codes <br /> HM ant!Padding N <br /> Pang Group(Fso. Type Ouzntay, WINd. <br /> 1f�llfia8. w'atir• •;, wtralr!fla• 7 fatA P '� 'I I <br /> yr�1 3�`T <br /> Z. <br /> W <br /> 3. <br /> a. <br /> 11.Special Handing Insbuctida and Addiaaal nibirmillim <br /> 15. GENEMTOR'SIOFFEWn CERTIFICATION: I hereby dedn M Fe cmwb of On co Wiz ent are fully ars am%ind8i described above by the proper dippig ram and aro dismaided,peaaped. <br /> marked and ddb,and are a as respects in paps ondsm krbenspori amartlig a appliaae inamatia,r rid reGpnal govxrxnenbl regulate ns.8 expel shipment ars I am the Prmry <br /> Esp«r.I m*Fd*lFebald*da of Inds mnsgnnem million, loft Nmss d the attached EPAM3moMedprnsm of Consent. <br /> pertly"me wine n1f11niaaYorl deterrent aenaed in 10 CFR 282.27(a)Id I am a lerpe Dandy generator)or(b)(d I am a sinal rpanely gwwabrl is we. <br /> y Year <br /> •.+ 18.Inlpna icrad SNp wts <br /> ZF ❑liryort to U.S. ❑Export horn US. Pal of erhyNd[ <br /> Tranh exports will Dab leasing U.S.: <br /> 17.TransyorbrAtlaraal rwg of Radial of Mad*ruls / <br /> ypetl Name Yew <br /> R >i i.,,l . e <br /> zit ranspaar yyed Name Day Yw <br /> 15 <br /> 1 18.0iaaepancy <br /> 1 as Discrepancy Indication Span [:1Qntrty ❑Type ❑Residue 1:1Paruai Reps ❑FW Repoeon <br /> Mandell Reference Number <br /> 18b.Named*Fadlty,(or Gensaar) U.S.EPA 10 Number <br /> V <br /> Q <br /> LL Fadli a PMre'. <br /> W 1&.$gakae of Allenak Faddy(or Gmwator) Month Day year <br /> a— <br /> N19.Hazardous Wasd*Report Menegenant Method Codes 0 it.codes for hazar0ars waeb bead ent,disposal and mcydrg sysd*mn) <br /> C 1. 2. J a. <br /> 20.Desgrated Faddy Oa ar or Operator Nic <br /> Ceiaoon of receipt of harardM materials covered by da manifest except as rated n Item Ise <br /> 1 PnnaNTyped Name Sgnature Month Day year <br /> EPA form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />