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Dei, 11. 2015— 1:56PM GE_ E N! LOWRY, INC No, 2950 P. 2
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<br />UNIFORM. HAZARDOUS 1. Generator ID Number ;Page 1 0( 0. taiergoncyResponse Phone < Mantfeai ackm Number 1
<br />WASTEM NIFEST e; pD trget i aS4 ��7 :1 %JJ31\ r
<br />5i Gene Name And Mallin Address$4 S'
<br />"� 9 :tfti, : ' '.;: . > ; 'o: • ,� Gens afodaslte Address (If differ t u, d ass
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<br />6. TransP P rfy orterI-Com a 'Name:• ... , .. :,�.•._<,.� ..�'.i, :. ;; .:: ,;:..:
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<br />Mary . •,t" . :• n :. Gib' : LJiS?EPA`ID:'Nutgd. p SE'rrrs-.:,!ii
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<br />8a. 9b.`i1.S Ql]T Deagiptlon (In�judlrig Pioper'Shipping Nerge,.gz8rd' �� n'�htniber,_. 3 - 7Q. ohlai�
<br />and Peckingdroup(ifeny)) 1 ,' G krer;>,::;, i31Ago)! :t'rllryl)>'• q'3'. staCodas
<br />1 Wd. Type, . Quantity W14W. wa
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<br />1lal: arldling Inahvctions andAdditione IntomtPtbn T
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<br />GENERATOR!FIt7FFFJ20R'S CEIiTIF1CATI0N , l hereby:declare that the tb iSan� of ft co 1411ment ere fully and accurateryd6sdrif;ed above by the ptoper shipping name aid a(q;deae fled yeck3qed
<br />rAallteE'elld:lA1S61edidpC�rtled, �d e'reln � reBAett3ltl propel.tohtlition for baneportecrording.ioappllWble lntemationaland natio gr govorn dotal regrilatipns Iit�ojtahprrl9rjPppli$SmJfia F�iulacDr
<br />•'. `-Expoiler,'I �arotyu,altne contents of this donaignmenl conforr11;W1hetemis of the'aftartiea EPAAdmoWedgntenl Of.COnsent. ti,. ;r
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<br />Transponv ante Q e Signature
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<br />18 Dlsaepa
<br />16a. Dlapepangylndicatioli $pCe
<br />❑ Quenttty' ❑TYPE . ❑ Raeldpe 1..._I PartieFR9fBGGOn ` ❑fill R6Jedlan .
<br />48blAflemate Facility (or Generator) U. ID bor
<br />ManifeetReference Number.
<br />3 EPA Num r.
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<br />c. 5 gne ie o emate a ty (or Generator) CrMh D w�
<br />r 19; Hazardoua Weste'RepoI Management Memod Codea (i.e.. codas for hazardous waste traatrnent, disposal, and recydlrg systems)
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<br />20. De9lgneted Facility Owner or Operator: Peitirieation of receipt of hazardouS n�3leAals cover d by the manVest except as nded In Ilam 18s
<br />note d Name fo" .-If 125 11
<br />signatue ✓'
<br />� 9r Day oa
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