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r'!a%se print or type.(Form desi$ried for use on eke{12 'rh)typewriter.) Form Approved,OMS No,2054-0039 <br /> UNIFORMW-IRM118 1.Generator ID Nun�er 2.Page 1 of 3.EmerWM Response Phone 4.Manifest Tracking Number <br /> wAsTE ti,mwm A L 0 0 f) 35 1 i F, 3 � "- 424-n, o I 0098 02203 .JJK <br /> t a.Ga Mratora Name and Malin Adtltass Generators Nte Address(if fiffarord ttarrmailing address) <br /> URY <br /> MO RAZI Ik WAY <br /> rRAC C-A, �N <br /> C-ener&es Phone; 29 W&4W{ <br /> &Trarsportt4erCorttparry Name U.S.EPA ID Nturber <br /> ► 7.Traromner 2 Company Nwre U,S.EPA ID Nutnber <br /> 3 Desi&ated Fadlity Name and Site Adortise U.S.EPA ID Number <br /> Fap'rtiy's x.77- <br /> ga. 94.US.DOT Desaiption(including Proper ShippiN Name,Hazard Clear,ID Number, 10,Cemtwrs11,Total 12:Unit 13,Waste Codes <br /> RM and PadUng Coup(if arry)) No. Type Quantity WLIW <br /> ARDOW W-ASTERSOUD OWE LA W. � �n � <br /> l <br /> tu 2. <br /> 3 <br /> I <br /> i <br /> I <br /> 4. > <br /> t S <br /> 14.Spedtt Handling Insfnrc8ons and Addtrlonal Infonnabon <br /> y �f tit} �{ ry�`Z WEPG#�`��r,,t ::BVI"P, ..E 0904'14�t i8 UPW <br /> P V ��'`� <br /> 15. GENERATOWSlOFFEROR'$CERT►FICATION:I hereby declare that the Contefft of this cons�=en!ane fully and accurstety desalbed above by th6 proper shipping name,and are dassiffed,pack*, <br /> marked and labaiedlplacarded.and are in all r aspects in proper condition for transport acooMj%to app&CiWe Intc_mational and national goverrvmentai regulatroms.If export st pmertt and I am rhe Primary <br /> ExportFr,l certl(y that Ute Contents of thea conaignment carlform to the terms of titre aftarsted EPAAcknowWgment of Consent. <br /> I certify tat the waste minknintion statement identified in 40 C.PR 26227(x)(91 am a large quantity generator)or( rf I am a g(�jI gwMity generator)is true. <br /> GeneratoralOtf-mes PrinWlTyped Naw—. ± _ Signature Mo Day Year <br /> 16.International IRpinmts <br /> ❑'mport to U.S. ❑Expor,from U.S. Port of entryretdt <br /> Trs VrACr agnawre(for exports only),. Date leaving U.S.: <br /> � <br /> 17.Transparter Ads>owledgm>ent of Recelpt of Mabenais <br /> t— <br /> Signature Mont (gay Year <br /> 4 Trartsporter2 Printedl7ypea N;InV Signature Momb Day Year <br /> f- <br /> 1&pisaepartcy <br /> 18x.Dmcreparcy IA6,Grtit Space ❑ Quarry T`pe ❑Residue IJ Partial Rajecbon ❑Pug Rek W <br /> Manifest Reference Number <br /> 1$4.Amato Facility(or Generator) U.S.EPA ID Number <br /> U <br /> 4�. FadliY5 PhOM, <br /> W 1$C,Sq;atura ofAkem. FacilEty(or G�rtsrdM MortlltDay Year <br /> a <br /> z <br /> 19.Hemrdotrs Wsok Report Management Metltod Godes(Le.,codes for hazardous waste realSnerg,dispnsat,and recycling systems) <br /> LU 1 2. 3. 4. <br /> a; <br /> 20.DesQnaW Faff4 Owner or Operxta.Calkadon of rgrreipt of hazardous m>s,enals covered by the m amliest exoept as nded in Om 18a <br /> Prot Name Signature Morph Day Yea y►A <br /> EPA l=am 0700-22(Rev 3-05) Previous edfons are obsolete. <br /> GRNERATOR'S INITIAL COPY <br /> POO/600 d 9VOb# 08:0L 71LOZ/LZ/80 <br />