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i <br /> -�8 g 144867 <br /> Please print or type.(Form designed for use on elite(12-pitch)lyipsivi Farm Approved.OMB No.20560039 <br /> UNIFORM HAZARDOUS 1.Generator lD Number 2.Pagolof 3.Emergency Response Phone -T4.-Manifest Tracking Number <br /> WASTE MANIFEST ��,_,- .x,33 F3 2 C877) F377-26691000039847 DAT <br /> 5.Generator's Name and MalfngAddmss Generators slteAddress(it owerent than malling address) <br /> S+tk 7ORLliITe PiRPOST SPAT M'OUIN PIRPORT <br /> :TORR PiRPONT ROY 5280 1IRPORT L1OY <br /> GensaWrs Phone: Sip�, ftii ?c _ -, ,7•.^ .T .NT'1S C 5 (2.9fi - 7 q <br /> S.Transporter 1 Company Name U.S.EPA ID Number <br /> e T r r., - - _ __ _ _ - t f Cali;001? LP ^GRE1QG21E'61 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fadllty Name and S'BeA.ddress - U.S.EPA ID Number <br /> KNURL '?IN`T'O F LLC MR Ps ENBIRO.`IOEN'PL SE910E5 <br /> I3RS3 -*,A r �Drf <br /> FacitiNsPhone . :YA. CR i5T f9 5) I-ROOD /rr '1 F1P9800841-83 <br /> 9a. 9b.U.S.DOT Descriptionhiduding Proper Shipping Name,Hazard Clan,ID Number, 10.Corminere 11,hlai 12.Unit 13.Waste Godes <br /> HM and Packing Gmup(dany)) No. Type Quantity Wt.N01. <br /> rr 1• S$1_:= HK EXTINGOISPERS 2.2 <br /> � DF 035 P <br /> 2. 1P'I55R PEROSP^S 2.3 <br /> (DC)I DCi �� P <br /> 3. 091110 CmS5W } (n-1 L 3 " , `'..0.5. (A9yiO iR, S7yIJ" InFlOXILE) �p <br /> X O PGII DF n <br /> 4. (191225 FLf E'LE "',1<", ".."'.:i;':lC, i't.O,S. (a'E,.OI G RUTS) 4.1 MIT 001 DF p y 0 P <br /> X <br /> 14.Spedal Handing Inshucticm wdAdcOonal Infamagon <br /> ?,' ;'_?_21; 'i Enr,(I2 ) PiRE ErIN&UI NERS (2) BE080210-"A - ERG(125) AEROSOLS, PRINTS, PE (3) BEIBRO60-00 <br /> 4:kFl " BSES, TREP (F# 0EO00410-00 - MUM FLRVETULC- SOLIDS, LA <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:Ihereby declare Net the contents of this mnslgnmentasfully and accurately described above by me propershipping name,and are dassied,packaged, <br /> marked and laeeledlpleoarded,and are In all respects In proper condition for Iansportacwtding to applicable intemeationaland natti governmental regulations.If export sNpmentand I am the Primary <br /> Exporter,I certify that the contents of this consignment confum to the termsof the attached EPAAdarmae tmConsent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)Of l am a large quanaty9ene or)or )Of masmallquanetyg9mndor)ts Irm. <br /> G aerrp Iore101 PrintedlTyped Name Signavu Month Day Year <br /> ,�� 5,3- Coco3 1 1w 1A0 <br /> 16.Intemalhrel Shipments <br /> ❑import to U.S. ❑Export hom U.S. Fort olenhy/exit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAckarovdedgment ofRecelpt ofMatedals <br /> H � nature Monty Day Year <br /> T • uteri Pdnled/P/p a r <br /> a c�hte err k � 3 0 b <br /> Tansperler2 PMlecirrypedName, Signature Month Day Year <br /> 18.Discrepancy <br /> 1S&Discrepancy Indication ❑ Qu, �❑ roan ❑Residua ❑Penial Refection El FJ Rejection <br /> / /� /onnv � D &� e/V �+ Manifest Reference Number. <br /> 186.Aparna F Ity(orG neaWr) -C �-��u0 L O- DPA. U.S.EPA ID Number <br /> W, G�a2 <br /> sQi Fadlhys Phone. <br /> 9/6 -X168-3aL�Fc��TD . meq- �j��a6 CAN /libGlBq <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1' 2. ---r- <br /> . 4 <br /> 20.Designated Facility Ovmeror Operator.Certification of receipt of hazardous materials covered by the mangest except as tided In Item 18a <br /> Pdnted ed NamaSgnatu.. Month Day Year <br /> 1 <br /> EPA Form 870622(Ra¢3-OS) revious effitiont are obsolete. iJDIESIGNATRDFACILITYTO IMSTINATION STATE(IF REQUINE}3) <br />