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I ' <br /> 1 <br /> - cc/.RG71 <br /> _asks=_d for use on elite l2- itch <br /> ( Pitch) FOEApproved.OMB No.2050-0039 <br /> 1 r..GR..!-,2ZAR000S 1.Gxnemtar lD Number 2.Pagelof 3.Emergency Responsephone 4ManttestTmcklnB Numher <br /> MANFIEST �tinilwµl6-1 <br /> 000039843 DAT <br /> c -�t;� <br /> =',x-eeMflBl6ngAdtlress Generamra Silemams(gdiRemnl than malling addreas) <br /> SIRR MOWN F.IRFOR <br /> d31X aOQO AiRPQRT 8FY <br /> -<--ea:tsPhona: QT 11 •, <br /> E.Transporter Company Name I { .'-T- . 4' - . . yA U - A <br /> - - U.S. AID Number <br /> -.- ... {:�a{rs•�L th,r: -ung _.r_..�1. Nan GPt .r. f <br /> 7.Trans paMr2Comparry Name - <br /> - - U.S EPA ID Number _ <br /> 8-Des.Igneed Fa city Name and SikAddroas - - U.S.EPA ID Number <br /> TfSTECR ENVIRO)?NEU'iAL <br /> 1120 SOUTH MEW ROAD <br /> Facet aPhone: F. '41 55735 f§2Q7 a78 41�} i(579 CG93259 <br /> 9a. 911.U.S.DOTDespdpdw(Including PmperShlpping Nene,Hazard Class][)Number, 10.ConpNem 11,.. - To@I 12. n <br /> - U8 <br /> HM and Pecking Group(if enyt) Type. Qum* 12.Unit 13.Weals Cada <br /> Ind 1' r.^.};' s FLf i?M;V—E LNUIR, HS (PROF=L!s CLYCOL) 3 FSII <br /> D11 1} <br /> 75 <br /> W 2. <br /> CD <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Worst Infmmaton 1 <br /> - l_7 Pf['VQ32R-RE - t5ci}1Qy ^,.'_Il i'1;`i_ylE<ii(I11Ft'r_"• <br /> 15: GENERATOR'SIOFFEROR'S CERTIFICATION:Iharebydl;:! at the contents of his cunsignmenrare fuay indaccuretey deecdbed <br /> marked and Iahefeshove by'he proper shipping name,and are dasshled,packaged, <br /> dlplacaNed,and are in all respects in ptopercondilion for transport according to applicable imematanaland national governmental regulators.It export shlpmenland I am the Primary <br /> Exporter,I caNfy that the contents of this consignment conform to Bb leans of the allached EPAAckn Mledgment of Consent. <br /> I cerfify that the waste miNreizaton statement identified in 40 CFR 26227(a)(ll am a largeyuanaty genemiot)or(b)(ttl am a small quaney generator)Is true. <br /> Genefatofsl0gemds Pnnledfryped Name Signature Month Day xer <br /> 5 S. G, zo <br /> -z 16.1n emafional6hlpmenls <br /> Import to U.S. ❑Export from U.S. Pod afentrylexit <br /> Tmnspoder signature(for exports only): Date leaving U.S.: 1 <br /> 17.TmnspaderAcknmUedgmentofReceipt oFMaterials <br /> T der 1 Pit to yped ams <br /> a 9 n a Month Day Year <br /> Ta der Prinumulypearmana l 6ignalure (� <br /> Manlh Day Year <br /> 18.Discrepancy <br /> 16a.Discrepancy Indication Space ❑ Ouadty []Type <br /> ❑Residue ❑partial Rejection El Full RelecBen <br /> Manifest Reference Number. <br /> 16b.A8emata FeGliy(dr Genemtm) U.S:EPA 10 Number � <br /> Fedllly's Phone: <br /> 18c.Signature ofAeemste Facility(or Generator) Month Day Year <br /> x <br /> CD <br /> 19.Hazardous Waste Rapod Management Method Coda ga,codes for hmrankma waste heahnenb cieposal,and recycling systems) <br /> 0 <br /> 1, <br /> 2. 3 4 <br /> 20.Designated FnffY 0wrrerMOpemlor.CBr6ficati0n Of receipt Of hemrEous materials covered by the manifest except as teed in Item 18a <br /> Pdntedriyped Name <br /> Signalum March Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATIOM STATE(IF REQUIRED) <br /> � I <br />