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D <br /> cl) NON-HAZARDOUS WASTE MANIFEST 3 1 N <br /> — CD <br /> O <br /> I � N O <br /> z 0 <br /> 1t NNor <br /> Fon nre:i OW Nc 295Q e(M C) <br /> --iu1 RY IMZAim0115 ,GV re <br /> o nt. 2 vy r 1 y r A a <br /> 10i MiCAMOOMME! I VJb r N FILE � <br /> z ,Nem.x•�AWI 15A.ARAesu nn wi m�.ry Nnefl <br /> fll Lw4 L;A 9&&V N Q <br /> (n +br.r.... :o,ne.w.+. u 5 ESM w,rw.r <br /> ' Aa wineRawrwtd Tir�t br_IOBA ACTto%" I- <br /> 2 FnA In N roper m <br /> O <br /> a a..ar.aw f,r♦y N—.0 go Allii LIS EVIL Ie Nwnbrrr a- <br /> [fin to <br /> E: 91vd rf T. rMC'°e72Z°He7T ; CD <br /> s Puw 5-.3�G-S"�Cf O <br /> y 9b r.z L+Lv'dvpb+I•wdV ry yen 5hw.V F Y,..Hard Ctas.Ie NW,Msr ,U CanIaXMR ,1 rora� 4�lhnl 13%Y N C.otln C�C <br /> Nu rsi oaarg 0.0 Id Nn ttype OUrMmv Vyy Nd G <br /> - I 12hfl ease P&ANX hnie,A.PCX p 17004 D= F � <br /> 21 O <br /> i L <br /> 7 <br /> () <br /> Q <br /> 0 <br /> O <br /> 11,1 <br /> H + <br /> N � <br /> O <br /> w�esandAdW*,a llr,b—Uon PrgW,Ntrriber 219154 l)ugm-ry t UAVW <br /> CL <br /> O EKE+=i AL'MI7GW '- CD <br /> O r' <br /> Q <br /> N GENFRATOR'SOFFEROR'S CERTIFICATION:I hereby declare NINe contents of Na cansgmerd <br /> eare lunyacc <br /> and urately descnhed atw a by the proper shipping name,art am clasaeed.pa 1Sa9ed. <br /> Q c n> W and ubeadlalar�tled.and am n an respeM in proper ax4bon hu Tanaprnt axoading m appluNe inlemahonal and mbw2l gm ernmental regulatpna-II eapod shrpmeal and;am the Pnmary 0' <br /> E.mrlar I 1'tml are�rrarnht dtha runsymnenl mnfprm Ip the lerlrcal the atlad,ed EPAAckndwledgmenl df Consent. :3 <br /> r am*the ae�asai rnnar"sga*+r>ent denhrrad In 40 CFR 262 27(a)(d i am a large gaanhty generalor)or(b)(if I an a Small guantry genaralor)is hue. � <br /> C Lmwall ls'gkrp's Praded7yped Name sgnahm Month Day00 <br /> Year <br /> Ail t6 Inner talk Snvner� <br /> j.. -.'t to u 5 ❑Ecport From U S Pan of entWexit. <br /> x Triraparter rfV EK"cr• Oaw leaving U-S.. <br /> MaMAS <br /> Signature Manlh gay Year <br /> O <br /> 4 <br /> N _ <br /> '�... - .. Signature Mento bay 'Yea; <br /> t— <br /> ib�epak} <br /> I"a y Indir:allon El 0.11T,ity ❑7,pe ❑Res ❑Paltal Relacton [IF iJ Relsrten <br /> idue <br /> Mandest Reference Number <br /> +8b Ale Fac ty foiC.. e, bar) U.S.EPA It3 Number <br /> JfJ _J <br /> 1 <br /> L Faddy,Phonic <br /> Li 1& �rnafe Sgnatsm o Faprw <br /> kty(aw Geaty) Month Day Yrer <br /> r <br /> a <br /> z <br /> y15 HaWftz Wae7'Report Mangan tin!Method Cedes II e..codes for hazardous waste treatment,disposal,and recycling syslems} <br /> 20 FaWdy OWrff o1 Oporafl#Cerahcabo of recelpl of hazardous materials wwred by the manifest except as nwd in Item 18a <br /> Priniiii Nems Signalwe Month bay Yeal <br /> O CD <br /> (Q (7 <br /> EPA Form 670022(Rev f2-17)Previous editions are Obsolete. GENERATOR'S INITIAL COPY O <br /> v a <br /> 3 — <br /> r <br /> GENERATOR'S <br /> INITIAL COPY o <br /> v <br /> m 00 <br /> 00 <br /> N W <br /> O <br /> 00 <br />