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PI "r for tree ort gRte,(12xitch tiypsv�ntsrt :, Form Approved.OMS No:2050-0039 <br /> 1,Genefator ID Number _....._ <br /> iJNI�Rb0U3 � 2.Page i'of '3.Emergerncy tieappn9e Phone 4:Wanlf+:st Thadtifng Number <br /> WASTE MANIFEST Joe L 0 0 0 3 6 1 1 W 3 dr'�d-9 •' 009810266 JJ:K <br /> 5-Generator's aiti'9 Generator's Site Address(il ddterent than mating address) <br /> MO AMO PUVA WAY <br /> 1PArlY CIS. 9M <br /> Gencwtoes Phor-: 2MB354821 <br /> 6.Trzapormr 1 Company Nam U.S.EPA ID Number <br /> Asaw TAL C CADa29273036 <br /> 7.Trmi sportef.2 Company Name FF U.S.FPA 1D Number <br /> S.Dc5gkAed Fad ay Narrw and 3iteAddrtr:s U.S EPA ID Number <br /> DEMENMs KBRDOW <br /> =N.ALAMEM STS <br /> COWON bra CA C A T 0 8001 3352 <br /> Fsality'S Prme' o fl�. aM <br /> ga. 9b.U.S.DOT Descriptio,(including Proper Shipping Name,Hazard Cla---,ID Number, 10.Gon�lners 11.Total 12.Unft <br /> HM and PadUng Group(if any)) No. j y Quantity 44tNd. t$.UWaM Codes <br /> 1. <br /> UNISIA 7' kSTE{-T:..*71'iNA&E LICIL J;KO-S, In S ,LAE }.fit: 7-G lP <br /> YJ41. \.7 <br /> 7wr NECESSARY <br /> 3`t:,� .SttJi.,:•_i:i+,'il !\:."si�7t.__'sl if .. _ <br /> - - - .►nynai i 5 <br /> f ERMG2ST-11l 31Iii1 3•=t 4:./4 }R!$TE f f11171An/. <br /> a. �t tF;S$ �iA� " ,y NUMBER F !S CA <br /> 1 <br /> t4,5pecW Handfrng! am Additional luta rnatlen <br /> a, _ <br /> EAR Y C 11dTAm T.'c>�C i 4-M t RC0 3 : PRORLE-F# -1 '3iW9'3iGAS,DIAL <br /> by Al 1016W7'APPROPMA'TE-PERSOW PMTXTFVE EWPI(erl <br /> 15. GENERATOR'SWFMMS,CERTIFICATION: I hereby declare that the contents of this owognment are t*and accurataly desatbed above dy rpe py;4w 5fi+PPeig name,and are dsss&d,paucago, <br /> marked and IabalaNplacarded and ere m al mVects in proper condFlon for Misport according to applicable urtems*nnal and national govemamtal reguWOrty.If ftpart shipment and I am the Primary <br /> E.xPo r.I certify that the Contents of this consignment UXdam to the tames of the aaKhed EPAAdwwledgment of Consent, <br /> cedt that the waste ninim2atlon staternwt iden€ified in 40 CFR 26227(a)(if l am a large quanSty generator)or(b)(P I am a smell quantlry generator)is true. <br /> Gement &X)iferoe$P Signature„ Month Day Year <br /> 16.intelmlimrorshipments <br /> Z , ❑Import to U.S. El Eq.frim U.S. Porf of entry <br /> Transpor,er Signature(for Botts only): late faav ng U.S_ <br /> W 17.7TartgPprtgrAdmoaAedgmentOFR¢CBiptofMe�rral, <br /> bTrarapoteriNnted)Typed� Sigr>Abxe Month Day Year <br /> a �3 Z <br /> Tranww 2 PrirdedTyped Nwe <br /> < V Signature Month Day Yea! <br /> t- <br /> is,Dwepanry <br /> 18e.waepatlty ktd-'-Spar ❑ Quantity ❑Type <br /> - ❑R.idue ❑Partial Re)eaion ❑Fuff Rejesxlon <br /> i . <br /> Manr7csi Refemoe Number <br /> 181).Afpernate Faaiity(or Generam U.S.EPA ID Number <br /> C3 <br /> w' <br /> Fps Phone: <br /> w 1 P,c.5ignatura of Altetrk f FaaTity(or Gentetetor) Mont Day Year <br /> z <br /> 19.Hazardous Waste Report Managernertt Method.C:Qd (•e.•codes for hazardous wase treprne�disposal,and recycling stems), <br /> 2. 3, q. <br /> 20.Dftigr aW Faa/aTf v Owner or OperaV CerlicaGOn of r9ceipt of hazmdous inefsriais covered by the manifest except as nded In Item 18a _ <br /> Name y Signatu - --.. Month Day Ear <br /> EP Form 7 72(R7.3-051 Previous ediii a afa d6solate. DESIGNATED FACILITY TO GENERATOR <br /> VZ : 9� 31.OV90/60 <br />