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Sep 14 2015 10:49AM HP FaxLadds Marina 2094779585 Page 7 <br />kir TTIV If l koSH SHI <br />Tease print Or We, Form des ned fa use on eRta 12-pit clrJ ly,ewrtler <br />` I�IFWtp�, ,q�ppps ?. Pay R�• Form A roveli. OMB No. 2D50-0039 <br />y t. (3EnerlllorlD <br />fIVASTL M�INIFES7, a <br />(lenorekr s;►dameand.MaYingAddress I • � b vd <br />�� {y} cx bt ey Cove n[[ �1� �j �i � . <br />rt�`fttitll Lrl4 71J4'.b ill <br />Gensratar's Ph,,. -477—%Rl <br />s,T f SEP 14. 2015 <br />rw— `.> VS, EPA IC Number <br />Transport, 2_ Comparry Name <br />(�C�I'n-J r1CD�C7T'4AC�1�1.S. EPA ID Number. .. ' <br />8.Desrgnate".a01dy'Nl***f Y1Qdr�8a..•,:YI. �{�(y]yy�M,yrvylye Ira S •Y-'TitWY{lK W'"WT _fyi}4f" <br />. <br />µE U.EPDmt9r;s <br />7 IHERRYES SA RCRD' <br />4488- 44 i —09"ire: 'SIU .MEX., CR 95113w <br />Fa0 's Phc <br />96. V.S. DOT Desaip%n (inchding Proper Shipphg Nerne. Hazard class, llmber, 10. cortaM9rs <br />Hm end Pt( *Q Group Ofarry)1 Nut?. torsi 12. una <br />No: Type Quantity WUVOI. 3. Waste Codes <br />SAM- <br />a��pWy� yyy �a�a�.�,�w .�{� y <br />S. 7• �.ARI)O'S.. Tm:lyJlfi�. +RYww►My. � 6: .'.•. `.• 1� W'7{70�'. �1F"lM'lK1I'i yf <br />sLl�igi'FTitiR1) # <br />1w x,I i Irk r <br />11! <br />14, S06dal Handling Instructions and itionar f7trrnatlon m <br />ani 3:ERf3 17f 9 INO ; <br />� 1 EW�F�TSI::�C'� ��.--•-•4FL�-3, l�£asb t� >✓ "I'F'x � <br />f5; DHgi(ATgR'S10FFEROR'9 CE RiIFlCATIDN i he `by delete that the coMerls of Ihls cons <br />fare y and accurate described above the r shipping name, and are classified, <br />marked 2rtd labe,ed/plagrded, and era in sli res cis in � by props lPF 9 padcagnd, .: . <br />pe proper condition forhansport eccordrng b a�licableIntemaibral end MOM! govelrmerttal requiations, 9 export shipmerrt and) am the Rim � <br />Expel lei, I eerily that the mn�nts of his consign nerd conform to the tenns.ot i+e attached EPA AcknoaNedg wt of Consent �Y <br />I cerdP� tharbrA waste minimization statement klerrafred in 4C CFR 262 27(a} (if I em a large .va iity generator) or(b) (If I am a small quantly gerlefator) is true, ; <br />eramr' rots Printed,,?ypad Name 0;�t <br />(Ho pay i <br />r ' <br />4. <br />16. Intemabonal Ship la <br />❑ Import to U.S, LJEsprit Som u.s. .- Pont o(enhykdt ' <br />Transporter signature jfor a)Morts only): <br />17.Transporterlycknawledgnteni of Receipt of P.latDo leavN U.S.:Trknerfals . <br />apo PAIDOrly ems $iyn, <br />pP'��^^• Mann Day 789P <br />P /Typed arra $igneirrte "r <br />Mo* Day Yo3F; <br />lgt r 1r1,11511dMaw <br />UT, <br />--,J ryP.9' LJ ResidueL ' LJ Partial Rejection Fuld RejacGon <br />6Aanifest Reference Nur>E • •r:' ' <br />tib, tUt(rrilatliFtltritp{rx 6er>.raic� U.S. EPA ID Nunber <br />Fagdit�6 Phone" °' <br />1& SIN*" of nate ad 4— a orator <br />orlth Cay Year <br />lei <br />19:.Haxardaus W to Reptut M t AieUgd Codes (i.e„ cogles for treardmrawesia trpehnent aspoad, a lel *Org systems; <br />4 <br />26 De gstedfagilY.Omer or <br />OpenMr. Cart) wan Of reeelp(d-h"dptX MdBllab t AMO eraGept as noted in Item l8 <br />Prir drr a r& <br />monm DIV. <br />a 77 `l" <br />EP F t3 00-fRgvOnvin 1s e ons e. <br />3.? Sl 1i �A1 I ATED FACILITYTO GENERATOR <br />