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Q1•Qt Zl <br /> ': 'A . <br /> JJK <br /> � I <br /> i <br /> i <br /> GENERATOR'S JffEROR'S CERTIFICATION `ereoy declare that the contents of th;s consignment are v.rr aril acara!er,:1e5::.^CcC acc:e a c,-,er;r cur;,ere aro Al"?:asWt- :avao e: <br /> NE a,r)Ff 3rd _c ;;s +p,:+Der card non for transport acceding to applicable rtema..cra+3r]-3Lrrai;c "r•rer•3i-i!Lia::c^; '-xXZU';rcrert anC am-e'-3r. <br /> «,orter er,iti rat!^e rete^rs cI < <.gnrent cor fon,'o the terns of the attached EPA Acknowledgmen t :ryrt <br /> cemly ma me waste m:mmcauon Varment der.Mied in 40 SFR Z62 27(a)(if I am a large quantity generator)ar b !,f! am a;;Wait yuan.r,e^e,atcr s;.e m <br /> Signature -a} <br /> CrFe-z's=,nted'Typed Name <br /> J J Import'o U S El Export from U S Pon of entry exit _ <br /> "'anSJprSe'_gnal.,re,or exp-0r's pnly) Dale!eamng S <br /> w ;—,nS(Y rer <br /> A,kncu"-og rrn!of Receipt of Yalenals _ <br /> :fntec?)ae,Namq Signature Montt, <br /> O <br /> Signaturea <br /> N <br /> a <br /> r - <br /> 6a D,s epancy Indicaton Space LJ Quanuty ll Type ❑Residue Pamat Rot: <br /> moef <br /> H 181)AWT.ate Facility(or C*neratorl <br /> J <br /> u- FaWf,ph" GI' IRA TOR <br /> w 1jy.S"ItiredAturraleFauuty(of Generatori � <br /> Z It is your responsibility to make a cop) <br /> a 13 H+tarkx)s Vfaste Re rat Manage,nent MetMd Codas p E <br /> ol,this"Cienerator s Initial Copy" '� <br /> mail it within 30 days to: <br /> Generator Manifests <br /> �. dt6d F.Aty 0.c,Gperawr Cr)n,;f,,.:rLnn of rw ��•���, <br /> rued P.O. Box 400 581?_0400 <br /> d SaCranICIIt0,CA <br /> "cPAFarrr87W22f.Rev 3f15) PrerwusrVltwnsarnobsoH) ENERATOR'S INI <br /> x- l <br /> 60 <br />