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F� <br /> tea:Ot'gC P.(?.BoaQp SStramartW,I...).Sti`'�'t?-0�CYI aNlhirt�'�,i- <br /> -- xr elite{t2•p;tch)typewnler,l <br /> CD <br /> 2 Pabu I a 3 En-.ancrPrt.rie <br /> 00- . JJ K <br /> Ge:r!ralo/s 6ReAW zt,tG,<e�nre�n���g „ r <br /> 6 rralspoyer r c..wny Name <br /> U;EPAID N.,&r <br /> u s.EPA to N�nser <br /> u.s EPA ID Number <br /> 9.US Dpi Lys;.-q;ba�f,nrJudrng Ru,er SMpPny Name Hazara Clan.iD Numher <br /> Hta curd°�-`r'9 u"•xR.`IRan <br /> rd n Taal v lhm <br /> � rh�anory .;'I-I I1 L:'ac!n Cqt:. <br /> O V <br /> r— <br /> Q <br /> xr <br /> A'+ z <br /> QtQ V <br /> I'r Spc_,al HarrJWg IrhruC�n<and AddNnnar rnfonnaux <br /> Mn <br /> - GENERATOR'SWFEROR'S CERTIFICATION:1 hereby declare Thal the contents of Ihrs com,gnwtmt are fully and accurately desrnbed above Oce V• <br /> Q+ 'arked a-!d fa0d¢d.'plarnrdpd.and are In all res is in r q' proper snyP�M name.and xe classified.packaged <br /> Pec p oiler condlR}r for tanspM according Io applrcabl2•ntematronal and natronal gwemmen!al regale{pis.if eVOrt shiment and t am the l't—ri <br /> Exparter.i cerbty that the contents of is consignment conform to the terms of the attached EFAAckrw,vledgment of Caownt. <br /> r cerufy mar bha waste rmnlm�lon stalemeol ptenbfied m JO CFR 262.Z7ta)(d 1 am a large quantity generator or <br /> "�"• 1 ro)(dl am a smart quantity generator)Is tnre. <br /> (� G.nerarorv0aerors Pnnfed7yoer,+Name <br /> p Slgnalum WA th Day h � <br /> Ib.lnfentaeonal Sl,ip•nen5 <br /> UImport to U S Export from U 5 ;r trr•, <br /> ty Tr;nsprrter srgnalum(for eX its only), - <br /> rrt+ 17 Trane ner Arkrlow Dalc le.h.rg u ti <br /> � M iadQmenlolRe�plolMatanafs <br /> A <br /> Transrwrter i Pooled/iype0 Nama <br /> �+ itgnature Nkx9h <br /> w.r. <br /> e7 Transporter 2 Pont Name <br /> P7 G3naWre h.lnn:h _.� <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spice ) 11 <br /> 7 Duanln'; U Type ❑Residue ❑Pamal Rejection L_J Full Rejeclion <br /> Manifest Refeo,.r iD lJumber <br /> 18G.Alramale Facility(or Generator) U S EPA ID Number <br /> 0 <br /> r-r- <br /> 0 acilify/s Phone: <br /> 18c.Signature of Alternate Facility(or Generator) <br /> Month Day 1'e.rr <br /> :3 Hazardous Wasle Report Management Melhod Codes(I a.,codes for hazardous h{.aste Neatmenl.dlspusal and racycling systems) N <br /> 0 2. 3 a a <br /> Z <br /> CDesignated Facility Owner or Operator Cediffcalion of recejpt of hazardous malerials covered by the nctmfesl except as nded In Item Ilia CIO~ <br /> (0 edrTyped Name Signature Month Day <br /> C <br /> 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'SINITIAI COPCTI <br /> -, <br /> N N <br />