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L b W W <br /> CCn CD <br /> O N O <br /> O C) D <br /> G _ W O C <br /> O <br /> 00 <br /> mN N <br /> = w iv <br /> U) <br /> rn � <br /> ..- °�'�"al ]kme.p.,x vfrn,,.iM Lm,• Farm t,`,M OM91✓.irl'Ar.nti3'i � <br /> ;„m,n,nss w d A.m,1ha mannp: 4'., J JK I/y <br /> v s ena,o r.�me�, <br /> u 6 EPA,D N•��m.r <br /> N <br /> p•r�• <br /> ' "=np�el�'Shipgr,g Ndme.Petard Gary.le Numpe, O <br /> 10.Conla,nan 11_T—I t�U��, t3.Wa9W Ga6¢s 0, <br /> No. Type Q-0, wtMol. y/CA <br /> t"r <br /> 1 CD <br /> HAWDESi <br /> ESTI • <br /> t--r <br /> _ � 0 <br /> .,,�pfa!Nandrrng Mst.�vcrrons and Additlonal Inhrmauon <br /> In <br /> - `.k]U WULS CD <br /> 'I"tAtF PPF F"olsfPM11CS <br /> 1a. GENERATUR'SIUFFEROR'S CERTfFICATIGM:I beret declare Ihat Iha ppnfeols of Nis consignment are tufty and acrarfately described above Uy Ne proper shipping name.and are classed,packaged. CD <br /> marked and IeCeled<placarded,and are in all respects in proper condition for transport according M applicable internaGenaland national govemmenlal regula5ons,Vt export shipment and i am the Fnmary Q.. <br /> F..Vorler.I ce*t 521 the corttenis of lhfs cons;,nil conform fo Ne terns oflhe attached EPAAWmIedgment of Consent. <br /> I Off*ffeat the aceta mlllhh aIfnn statement identified it 40 CFR 262 27(a)(if I am a large quantity generator)or(b)(41 am a small quantity generator}is true. Month gay near <br /> Generak>TarOXemr's Pdnred"hyped Name Signature O <br /> 16.fnlemapona!ShipmentsPort of en le-it <br /> f– ❑Impon to U.S. ❑Expmrt fmm U.S. <br /> Z Transporter signature ffar exports only). Date keaving U-S.', <br /> 1T 7raRspoyerpyvgwfed3menl orRc rpt olMaredals Montt+ Day Year iF.$' <br /> Trarsporw t Frmted'ryped Name Signature Q- <br /> 6 <br /> Month Day Year ¢, <br /> TrarsparW2 PrrnladTYped Name SignatVrs CD <br /> ' 16.r.4so'dr�TrGy _ <br /> 183 DOOWWXY 1ndAwon sotte ❑Ouanfrry ❑Type ❑Residue ❑Parliat Rejection ❑PWY ReyeclionCD <br /> C... <br /> Manifest Reference Number, <br /> aAflerraadaF ty(ofGerrevator) U.S.EPA 0 Number n <br /> "Sphone. n <br /> Mgife CfAlleMlate Fadfity(or Generator) Month 4ay O <br /> C� <br /> WW"Report Management Method CDdes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O <br /> o <br /> (0 O <br /> "ORO 0397erorOPerator CerliAcaffon olreceipt ofhazardous materials covered by the manifest except as noted in Item 1 as <br /> ria Signature Month <br /> o <br /> �D <br /> –0 V.3-05) previous editions are obsolete. <br /> Cn <br /> Cm GENERATOR'S 1N <br /> CD -PI <br /> 00 <br /> W � <br /> O <br /> er <br />