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Form Aoproved,,OMS NO-2050-OD39 <br /> 2-pitch)lypewn-.i <br /> e e,(Fdhn d ed for use on eft 0: 2.Pap 1 01 Emergepoy Response Phone e)nqq.i A7 J <br /> 1 Generator ID NUMW <br /> Tracking um er <br /> M HAZARDOUS <br /> WE MANIFEST Genarelofs ft Address(�d.vrgrn there 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 Ai�im", -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 /> 10.conta 13,waste Code <br /> ga 9b:6:8.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No, Type Wenlity <br /> HM and Paddng Group�IMM <br /> •f ylk"v V0 fl-..1! i ? JV(' <br /> 67 <br /> ---17— <br /> . -7 <br /> 4. <br /> TrSp;M� 9andaong n9*_h i'i I Wd Add UM in <br /> �V <br /> *a p*lgedj <br /> 4MFxms.end are <br /> ;;;;;am fully and e�; above by the proper S4 <br /> by Traft described <br /> d that the contents of this m"151 9 export al0imerd and I ail <br /> T5.—GENEMM-810"EROWS ore transport a=rdin to applicaWe Intemationaland national regubitlons. <br /> marked and labeled/loacalded.and am in all respects In Proper condition for <br /> to the Wm of the bdied EPAAdqpMedgment of Consent. <br /> � Primary <br /> Exporter,I certify that the contents of this oorl*nment conform pTga qmn*gtnerW or(b)(if I OM a SUR qWrft 9WW*D�ir,tVj- <br /> I certify W the waste minirnimton sMrMW identified in 40 CFR 2R27(e)(it I an 0 orgh <br /> prin"Pfypod Name <br /> Gew* <br /> -1F.-inisToone l Shipments. ❑irn�rt to U.S. Dot lu*g LPG.:EXWfr0M U.S. Pan of ewp"at <br /> Transporter signature(for exports 0111A <br /> 1I;,,Transporter Aftowk*msnI of ReoW of mawnasMonin 'M <br /> d/Typee <br /> aT <br /> TOW <br /> SIgnature Month Day <br /> Transponer 2.printed7yped Name <br /> I B. o * ❑partial Rejedl-A <br /> IS&Diiareperm Indication Spar* u, Typo Residue ❑Full Rejection <br /> U.S-EPA ID Number <br /> 1 ob,Alternate Pacllk(or Generator) <br /> FacilidYa Phone: Month DR /yeu <br /> ft.som-,of Rifamate FOCIMY(or Generator) <br /> ti <br /> 1 2M (i.e.,cad"for hazardous waste treatmenttreatment do p0881,am rscVdnq spiems) <br /> 1 Os Hazardous Waste Report management Method es <br /> 2. <br /> zo.Designated Facility Owner or Operator.Certification of receipt of hazardous materials mvmd VY M manifest except as noled in Item'As Day ear <br /> FRRR?f;�ed NameEPA Form I I I I <br /> 10-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> 90 *d tV:q[ OLOZ CZ Inp 016199V60Z:X8A 10d ]a NVA <br />