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Form Aoproved,,OMS NO- 2050-OD39 <br />e e, (Fdhn d ed for use on eft 0: 2 -pitch) lypewn-.i <br />1 Generator ID NUMW <br />2. Pap 1 01 <br />Tracking um er <br />Emergepoy Response Phone e)nqq.i <br />A7 J <br />M HAZARDOUS <br />WE MANIFEST <br />Genarelofs ft Address (�d. vrgrn then mating address)fingAddress <br />5, Genete6Dre ante and <br />"4 4't- AAi <br />gienwajtgf_s PhoR-j EPA ID Number <br />le- <br />e. Transporter 1 mpany Rame <br />i Aiim", -Us 5PAIDNumWbW <br />7. s"r 2 Company Name <br />Nu r <br />B. Desi ....... <br />Ik; <br />rA I <br />'T (910) 1 <br />Feil it'sPhone; re urlit <br />Shipping Name, Hazard Class, ID Number, 10. conta <br />13, waste Code <br />ga 9b: 6:8. DOT Description (irWuding Proper <br />No, <br />Type Wenlity <br />HM and Paddng Group i IMM <br />f ylk "v V0 fl-.. 1! <br />i ? JV(' <br />67 <br />--- <br />17— <br />.-7 <br />TrSp;M �9andaong n9*_h i'i I Wd Add UM in <br />4. <br />�V <br />;;;;;am fully and e�;above by the proper S4 4MFxms. end are *a p*lgedj <br />by Traft described <br />d that the contents of this m"151 9 export al0imerd and I ail Printery <br />T5. —GENEMM-810"EROWS ore regubitlons. <br />labeled/loacalded. and am in all respects In Proper condition for transport a=rdin to applicable Intemationaland national <br />� <br />marked and to the Wm of the bdied EPAAdqpMedgment of Consent. <br />conform <br />Exporter, I certify that the contents of this oorl*nment <br />the sMrMW identified in 40 CFR 2R27(e) (it I an 0 pTga qmn* gtnerW or (b) (if I OM a SUR qWrft 9WW*D� ir, tVj- <br />orgh <br />I certify W waste minirnimton <br />Gew* prin"Pfypod Name <br />-1F.-inisToone l Shipments. irn�rt to ❑ U.S. EXWfr0M U.S. Pan of ewp"at <br />Dot lu*g LPG.: <br />Transporter signature (for exports only): <br />1I;,, Transporter Aftowk*msnI of ReoW of mawnasMonin <br />'M <br />d/Typee <br />aO T <br />SIgnature <br />Month Day TOW <br />Transponer 2.printed7yped Name <br />I B. <br />Residue❑ partial Rejedl-A <br />❑Full Rejection <br />IS& Diiareperm Indication Space Typo <br />ou,* <br />R <br />U.S-artiest <br />EPA ID Number <br />1 ob, Alternate Pacllk (or Generator) <br />FacilidYa Phone: <br />Month DR /yeu <br />ft. som-,of AIW ate FOCIMY (or Generator) <br />ti <br />1 2M <br />1 Os Hazardous haste Report management Method es (i.e., cad" for hazardous waste bubrMA am rscVdnq spiems) <br />2. <br />of hazardous materials mvmd VY M manifest except as noted in Item 'As <br />zo. Designated Facility Owner or Operator. Certification of receipt <br />Day ear <br />I <br />FRRR?f;�ed NameEPA <br />I I I <br />GENERATOR'S INITIAL COPY <br />Form 10-22 (Rev. 3-05) Previous editions are obsolete. <br />90*d tV:q[ OLOZ CZ Inp 016199V60Z:X8A 10d <br />]a NVA <br />