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Plannot nr hma X^rm riadnnart fnr um nn alita 119.nitrhl tvnawritar 1 <br />Form Approved. OMB No. 2050-0039 <br />crA t-orm vuu-11 (Rev. 3-05) Previous editions are obsolete. <br />UNIFORM HAZARDOUS <br />I Generator tD Number <br />2 Pa;e 1 of <br />3 Er-ergency Resp;, -se crc-e <br />nib-/ <br />4. Manifest Tracking Number <br />1008960848 JJ K <br />WASTE MANIFEST <br />A S G <br />S37 <br />5 Gererator's Name and Mailing Address Generators Site Address (if differ nt than mailing address) <br />10 £h vs reP%A en1 -� <br />?S'.s7 CetrrGlo o -v f, <br />9�! ftobjhY9y r,� e0. s3Gti <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />1,V17 'SA �,,� `,.l 120oo ,(V'Z <br />7 Trarsporter 2 Company Name U S. EPA ID Number <br />d. Designated Facility Name and S +.e Address 0/ s? 6 6 S6 s S/g61 U S. EPA ID Number <br />Pxc.ojj,do,& remo-miry <br />X Mexi eo, s. A. D.6 Ica- I v - 4 7-10 <br />CARfCV Mex I <br />Fachtys Phcr.e No - ,% co e . s- .ewk <br />oa <br />9b U S DOT Description (including Proper Shipping Name. Hazard Class. ID Number. <br />10 Conta,ners <br />11. Total <br />12. Un t <br />No <br />Type <br />HM <br />and Packing Group if any)) <br />Qua^: ry <br />AI "Gl <br />' AJOU &A -A k�-01s � s ` I'� ord. <br />612 <br />9 <br />C1 d 1 wa4e� <br />Dl vl0 <br />C <br />Uj <br />1 UNl;L63 "Sk Pe -"Ai Wa.14-d M04er,& S 3 P� <br />cf. <br />f10 <br />P <br />0001 <br />3 <br />s <br />..._: a-a^d!nd nstrle'ro^s ard.Advonal Irtormaion <br />q61 Yx ss <br />96.2 -4 Icyd. <br />5 GENERATOR'S10FFEROR'S CERTIFICATION: I ne-e:, :Kate tham the converts of � s consignment are fully and accuratey described abohe by The proper snipping name, ab are ciass,fed. pack33e' <br />marked and labeled placarded, and are In all respects m proper condition for transport according to apphcabie mtemational and national governmental regulations if export shipment an j am the Pnma-r <br />Exporter, I certify that the contents of this consignment confori to the terms of the attached EPA Acknowledgment of Consent <br />I certify that the waste minimization statement identified in 40 CFR 262 27(a) (if I am a farce uanMy generator, c, Ito is I a^ a small cuani gereratdr) is true. <br />Day ea' <br />Gereraioes'Offerors Printed:Typed Name Signior -4 <br />J <br />Z <br />16. IntemahD . 1 Shipments <br />❑ Import io U.S. El Export from U.S. Port of entryexit: _- <br />- <br />Trarsoorter signature Ifor exports only): Date leaving U.S.: <br />W <br />W <br />17 T-a^spoaer Acknowledgment of Receipt of Materials <br />F- <br />Trans ..^.er 1 PdnTedTyped Name Signature :: ^.r Day Year <br />C <br />Noy <br />-71Z -*4 1.1 -,,.?. - <br />Z <br />Q <br />Transporter 1 Pnn:ed• ped Name Signature Month Day fear <br />, <br />r <br />3 D,sceoancy <br />38. C screpancy Indication Space El Quantityy <br />E]T pe ❑ Residue ❑ Partial Refection Full Rejection <br />Manifest Reference Number. <br />13D ;i!er-a:e Fac by, (or Genera?or) U S. EPA ID Number <br />J_ <br />U <br />Fadrtys Phone <br />LOU <br />13c. Signature of Ahemale Facdiy ,or Generator) <br />Month Day Year <br />a <br />z <br />rn <br />19 Hazardous Waste Report Management Method Codes (i a , codes for hazardous waste treatment. disposal and recychr s x rrs <br />aS 9 i-'e <br />W <br />0 <br />2. <br />3 <br />4. <br />2. Designamed Facility Omer or Operator. Certification of recent of hazardous mateca:s c.ere =-r :re manifest except as noted ,n <br />P ntedrTyped Name Sgnature Morin Day Year <br />crA t-orm vuu-11 (Rev. 3-05) Previous editions are obsolete. <br />