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02(2S/2CAS 15: 3E SIS-272-1172 - lgALTDN ENGi^EERING- PAGE 02 <br /> U U <br /> Please print Or type.(Form deeignod for use on elite(12 phh tyevnitec) <br /> r7Nom <br /> ORM HAZARDOUS 1.Ganeaitar O NUmae Folin Ap vod,OME No,2050.0039 <br /> 2.PBge of 3.Emnrgoecy Rmpbnsa Phann 4.Manifest T�raaming Numgberr a� <br /> ASTE MANIFEST d," r 0, o P.t '? .I " "JS I"�2'Y-cW 9 4.F CJ G..& .,A,L G ��' <br /> Mmtoet Name and Mall Address - GBnetalp!sSlfegtltlroes(If tll9amnt than malllryq atldress} <br /> q�i ?k H�f'.L�ta FTrPff�r��� , ��0`.ratofs Phone: .r O L1ni fal 1 Company Name <br /> M llgv .pv*:'iLM Wfd 'IU.6.EPAIDNamborp) .r fonspoder2 Comparry NameU.S.EAA ID NUmbOf <br /> ,�l iBd EBWiI ams a C -� U.S.EPA ID Number <br /> i 4 caw;nrY�q;f aP:Rw �y.cr{ /, r! pmr.n h,(,'Yr^r1 k7 ,r 1; o fT'IPAdJ.�A,L'iI;}SPhone:fgfifr ?h3.,;�' q rr <br /> ga Pb.U.S.DOT Dasarlptloa(mDludlnp Proper Shipping Name,Ha'lan7 Class,ID NumM1ot 10.Cantel9em fl.Total 12.Unit <br /> HM and PacidlM Group(If any)) ' No, Type Quantity 12.Unit <br /> 13,Waste Codas <br /> . 1 Y - iii I Iarysrr�Nkiirr trr Ir+"e ,.., <br /> �'. <br /> ry La' e"''}}Y 00 <br /> Z 2, <br /> � I <br /> a. <br /> 4. <br /> 14 Sfedal Nantliing InamJCM1dnB arld Adonal Imorm911Dn <br /> .01-,1 <br /> er i' s) ,.Fdr7 <br /> ' rt*„fir 9'�'f;r}r' .^+,GI R."`GE7n7 Fi%3VR. CBtu, pTE71 .F-I AlsT, ue YE <br /> 15, GENERATOR'SfDFFEROWSCERTInCATION; Ihomby derJere fhffi thewntanfs OftmB Danaignmen:9m(qtly antl exumtOiy dearlbad above by pie pmpa!Rhlpping mma,em are classified,packeoed, <br /> y marked and laboled!placardod,and am In all respects in prepor condition fortronspo i nceoroing to applicable h ier mlonaland national aovernmOnte(regulONons,1(o$and shipment and I am the Primary <br /> Exporter,I cerdfy ihatthe contents of thla consignment conform to the lama of[reattached FRAkknovdedgmcnl of Lonsent. <br /> I CBItHy dist(ha weals mintmimtlon statement Itlerdlpad In 4G CFR 26737(a)¶f am a terga quan9ty pOnetalor)or(b)(nl se a small quantity genBtatOrJ 1s.inre, <br /> Ggpeialor'SIOReroys PdntetlRyped Naina SIgn,OtUmIt <br /> Monro 'Day Yoar <br /> F 15.IMemeponal Shipments' ,+ : .,y <br /> z ❑Inewtto U.S, ❑Even film U'S'. /'Yed of,anlrylert <br /> Traaaportorslgnature(forokponsonly)I k"' Date leaving U.S.: <br /> cd 17,TransponerAckwMedpmantnfRewleteMdterals J <br /> . Transponor l Pdnted/Iypad Na <br /> me Slgnfllura ,�s MD <br /> Pih - Pay Year <br /> mnspoder2 PdnlealTyped Name "- SI ��.--^'� <br /> Nro " "�--�.r Meals Day YLAr <br /> 18.Discrepancy r-.. . <br /> tea.Discrepancy indidalfon Space ❑ Ouenilly ❑Typo <br /> ❑Residue <br /> ❑PedNl Rnfooppn ❑Full P.Jeclbrl <br /> r <br /> 18 D.Aftomata Faeplty(Or GeIF110r) Manilas:RafemnoP Hum o" <br /> en ( - U.S.EPA ID Numhor <br /> J <br /> ua- Facpiry's Phone; <br /> TT79neture.atAltamare Faoplty(or Genomtor) _ month Pay Year <br /> a <br /> 2 <br /> W1a.HT&moua Waste Report Aanagament Method Codes(i.e.,codes for hamdom waste Imalme9l,disposal,and 2cycling systems) <br /> LPtli'l2O.DesiC Fgnaleaciwnlity Oer peratorCeNfmaM1an orrecall of hazardous materials CNN.d by the manifest except as nelod In Item 18a <br /> lOdfiyped Nan Signature - Month Day Year <br /> EPA Form 87D022(Rev,3"05) Previous editions are obsolete. <br /> GENERATOR'S WITIAL COPY <br />