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Sep. 1 2010 9:40AM GB Industrial Spray Inc. I No. 4727 <br /> ---- rr-- d,om P. 7350-0039 <br /> lease print or type,(Form designed for use an elite 112-pitch)tYP 2.F 1 or EmergencyResponn Phonejairiffest Trsckiv Number <br /> I Generator 10 Number UNIFORM HAZARDOUS FLE <br /> .VyASTE MANIFEST ne <br /> S. N and Making Address <br /> ql, <br /> .......... <br /> 0 NuNumberoter 1 QoMpany Name <br /> FLE <br /> ranspo <br /> ,dd,.,) <br /> u,s-EPA 10 Number <br /> 7.Transporter 2 Company No" <br /> EPA ID <br /> e.Designated Oak and SiteAftm <br /> FaC1111A S Phone: 10,Containers 11.Tow 1,Unit 13.Waste Codes <br /> 91 9b.U.S DOT Desd9lic."'(including Proper aq*g Nwie,Hatard Class,ID NUMber, No. TYpe Quantity <br /> HM and Pecking Group(il'any)) <br /> U.1 <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling jnsUtirlions and Additional Information <br /> name,and are d855111 Pack"Sild, <br /> the Per SNP* <br /> mef..yanda=rsm ascdbsdatoval�y apfol <br /> 0 and I am The Primary <br /> 15. rJ!NERAT0TVSJ0FFER0R" GERVICATION' I hereby declare that the wrlie long,govemrpental regulations.If export <br /> marked and labeted/pIscarded,and are In all(elpects in proper corMion for barksport according 10 applicable kftmali0al end na <br /> t Conforr,lo the tWMS of The Attached EPA AdkrviAe4ment of Consent- <br /> I certify Thal the contents Of lKis co*nmwl I am a Wga quaAoty generator)or(b)(K I arn.a smart quanfity generator).alor)Is true, on oar <br /> Expo <br /> I NoIN that ihowaslofnimintzatiOn statement Wenl&d in 40CFR262.27(a)(i <br /> e(O 5PnAtec1r[yP8d ams4. <br /> enMt <br /> Pon of ent('119AL <br /> ❑Export ffcm U5 <br /> -1 16.Intemallonal Shipments kp.1 to U.s. Dateieavlc U.S.: <br /> nature for 0o3onl on ay <br /> Trans BT sl 1 <br /> W 17.Tip spn,AckrwWgment(if ROWPt Of malloals tgnature .1 <br /> Trmansp oar Rhn CVTyped Nall ay Ear <br /> on <br /> 2f Tfansooder 2,1?rirlledl Ped Nam Ji I <br /> Full Rejection <br /> 18.Discrepancy F-]Typ- Residue E:]Paola]R�ediOrl <br /> 18a.DISerePTCY Indication Space QuanblY <br /> Maoe$j Reference N'T7nb0r U.S.EPA 10 Number <br /> 18b.Alternate Facility( I Generator) Month Day Year <br /> LL Facilt .5 Phone: <br /> 18c,Signature mate 1`301Y(OT G-@'aloo <br /> haUrdOus WHSIL trealtr[len, disposal,and icy n9 <br /> systems) <br /> ng 4. <br /> 3. <br /> Molhod Codes(i.e.,V jq.Hazardous Waste RUP01 Management2. <br /> IC& as no in I(eirn 18a <br /> receipt 01 oazefdous matMai$ verea by the 018111fut except as no —y" <br /> Q Ce tDay Y! <br /> ' of facalga <br /> 20,oe4lialed Fack�y OINTI <br /> 2 <br /> PriniedfTyPed ams <br /> '" I 110 DESIGNATED FACILITY TO GP" <br /> .............. <br /> S editions are obSolelel <br /> EPA Fo 22(Rev.3-46) Pro" <br />