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4.M racKrna um r JJ K .
<br /> ttch)tvaswn er. 1 of 3.Emargency Response Pfmne
<br /> piiRt Or Form pest iso for uas
<br /> on site(1� 2.Pam .003
<br /> Genie nerator ID Number 1 of) 746-7 '9
<br /> RDOUS' Ganarator s Site Address(if differant}tltan maliing address)
<br /> NIFoRM HA7A xm,}4�fi$ !
<br /> WASTE MANIFEST ' -
<br /> ess
<br /> Generators Name and pAaTj S- fS r-WA.,r) l
<br /> SLl#VI T(QST, Fft9'T RD-
<br /> Bfa� A U.S.EPA ID Number l
<br /> TRA+:Y, 377
<br /> Ug••633-01 ' h pri-ate GkUDLa6d6497
<br /> 3eneratoe$Phone: ^CtsA has.�11E+ a�Pr� U.S.EPA ID Number l
<br /> 3 Transporter 1 Company Name U G IV t
<br /> SHOP l RDSSOLL 6o�f•4S permots Orr a
<br /> 7.Transporter 2 Company Name t41`4 ®� is U.S.EPA ID Number
<br /> :..6"OpgI3$l� 1 s
<br /> 6 ��� a ply t1U tO P!r7t3tl^ c. shipping.
<br /> }
<br /> { HCHG CCR it.Total 12.Unit %Waste Codes I
<br /> 8'1t�359-Uti� 10.Cordelners quantity Wt,IVol. r
<br /> Fadlity's Phone: r cppiRg Name,Hazard Class,ID Number No. Type
<br /> trduding Props DF F U>3Pl2 'i41
<br /> 98. 9b.U.S.DOT Description(t I !
<br /> and Paddttg Group(d any)) 4
<br /> C uDBif+cffCsSt �S.4!).Uii2h�iP,pI11a,
<br /> l },t . l� 'f5r3ritRRC - 0 .
<br /> (4=(wet'ttYri0,-1T3r�r�JriN DF ..
<br /> C,1wORG, lir N •S•,6,UN3266,lH
<br /> U „p jv.l.JRRC7,r4'Vd 1..1O NIBS, rIn"od exCIs�'�w
<br /> „ W (p r�i�Itsi -ark�ear, :�tEassit�fr!4 i p 352
<br /> GF
<br /> TE SOUP,W'�.5.,b:i+A3077,lii'(�LL��F HJkl f� ) �i '�j+G►4�
<br /> sRDOUS l
<br /> PAPEM C F �Cr�
<br /> 6tCCUSWtiACy73^LtC1
<br /> 4. NOWRCRA H .. t
<br /> eta:r�Yrfy1'aane+>�t�m
<br /> 8;t -PrctEil , FSO r Y kiDtr. t Tn ct#I
<br /> l SRC 0 7.
<br /> 14.S1 er-al Handling Inskudions and Additional In on ERC-4-4"14"
<br /> (isl}_p�tie#R7�+�Zh 'c'rttrtaaal i=,rrhsrt#,
<br /> 917:13-Frr 6114 #R -War l,Slid%t1�roto pw` r, F'•C3#�:fi i -t : 3 �4-pryfifl�t name,and are dassifiied,pa�*aged,
<br /> and acarrately described above toy iha proper shipping rt strfpmant.and I am the pinery
<br /> nmment are fully al and national governmsntel regulations.If expo
<br /> FlCATION:1 hereby deders thatthe contents of this cat�t9 firaible inte mason
<br /> In r reottdition transport according to app Rerawr)is true. pay Year
<br /> 15. DEN ERATOR'S10FPEROR S C nest rm to the �o[ Month
<br /> �,�,r,, temx3 o7�ihe attadre eEtP�AnAclmoMea�)or(b) aim a small Quardl►y 9a
<br /> marked and labeledlplacarded,and are in all respects P 9Pe r i a large 9 ty g .-- '
<br /> Exporter,I certBY that the contents of this consign x,40 CFR 262 27 a)Q Signa t
<br /> Is {mization statement identlfled im,\ J/
<br /> Ice t ,/' l 1') r' q -���f
<br /> Gen r'' tat n dR�{pediN _ r>� lam ,,'
<br /> . %I . ❑�d�U.S. Pott of en"leaving
<br /> U.S.;ffift
<br /> Date leavhtg U.S
<br /> ..t 16.Internatl,al merits �❑import to U.S. Mouth Day Year
<br /> Trenspori
<br /> �— .
<br /> z ar si amore(for exporls only): of Materials Signature
<br /> a 17.Tranapo rAckr«r Aed9mentofReceiPt M nth Year
<br /> Trans 1 Pr, Ypec,Name
<br /> Sigaature
<br /> rn Transpotier 2 PdntediTyped Name
<br /> ❑ Full Re)ec
<br /> Partial Reisctlon ❑ tron
<br /> 18.Discrepancy CITYP. ❑Residue
<br /> 46a,Discrepancy Indication Space ❑ ouanow Manifest Reference Number.
<br /> U.S.EPA ID Number
<br /> pY 16b.Adrenals Fadfity for Generaicr) Year
<br /> Month Day
<br /> J
<br /> U
<br /> w Factikys Phone: or Generator}
<br /> W18c.Signswre of p items te Fa-Ity( stems
<br /> Q die osal,and racyding Ys } A
<br /> anent Method Codes 0.e.,¢odes for hazardous vmste 070 di 4 dam.
<br /> Z Manag `
<br /> 3. d
<br /> 19.Hazardous Waste Report
<br /> LLI 0 1 Month Day Ye
<br /> (J the manifest except as octad in Item 188 n i
<br /> calor.Certification of receipt of hazardous materials coveredby Signawre :+
<br /> Owner or
<br /> operator. ( ° i;"1 :`'
<br /> 20.Designated Facility r i
<br /> ../,
<br /> i PfintedffyPed Name ? pESiGNAt' FAC1l 1TY TO GENEp,ATC
<br /> solete. _—
<br /> I ) Previous en'are'bb ,— ——--—
<br /> yl EPA Form 8700-22 ditioi
<br /> (Rev.3-05
<br />
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