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W N <br /> Cl) O N O <br /> O _ rn N <br /> o m <br /> N <br /> D - <br /> C) C) <br /> '. <br /> D Please Timor lYpe .r -ro N�,�nn,• _ 2 Pr,ge for 1 E Form Appm,eA 4MB Wi 20'.A�i934 W � <br /> 1tN1FOAM krAIARL0U5 ' rPr`nry Rest+rine vnr:rw e.Nxnllal TrlMMMp xu 0 <br /> 77 r�sr r. t N <br /> lYASTE IN.4M ��xr.•,. - FLE o <br /> M �.c an'S'N•T+Y ant>•,a:I a: �+aM'+lIW,SrW AOnn ss pE M-1-than maxuq vi41m¢ N <br /> -rv Q <br /> W —n <br /> �KrwrekvS xgv.e' <br /> 7- <br /> 0 O <br /> rte"'i' �•N r r o f EFAIG rvumber 6 <br /> O <br /> F.n'.hM Nuns cent SaePdd+ass < <br /> a <br /> US EPA la Number CD <br /> _ Q <br /> ?b U.S_LOT D-- W-Iry iWM Proper Slllppng NsmP.#tazard Class,I�Number 10.L.onlainers 3 <br /> Hkl PackNV C; uP,l an L'1` 11 ntity WINN <br /> No Type Ouanhty WINN 13 Wada Cortes 7 <br /> O <br /> sT. <br /> U <br /> W M <br /> W Q <br /> fJ 0 <br /> O <br /> l <br /> O <br /> 1 <br /> Q <br /> M <br /> Spy a'Flanarit;h15$Ixbans and Addirional hbratiation 7 <br /> v <br /> [ O, <br /> 7 <br /> GENERATOR'S.r06"FFJ20R'S L€RTIFICATfON:I hereby declare that the contents of this consignment are fully and accurately described above W the pmSper shipping name,and are Gassi5e6.Paclraged. 0 <br /> parsed and 4hei adplacmded,and am,n ant respects in proper condition for transport according to appItable intemtinnai and mhanm <br /> al governmental regulations.If export shipment and I am She Primary <br /> Experlar I Brat ft carAents of this mnslgnment conform to Inc terms of the attached EPAAcknowiedgmenl el Consent <br /> 'Wr"'flee xgsk mimml¢a6m stazemerl identified in 40 CFR 262 Mat(if 1 am a large quantity generator)w(bl(IIl am a small quantty generator)5Irue <br /> Ger, aiW&01`L es Prmied?yped Name Signature 1:!orAh ]a� tcar <br /> lI <br /> zj iE inwnalwr SMpmars ❑lmport to LS Export from U.S. PodoreruyeM <br /> P— <br /> M <br /> 2 Transporlpr sgnature i`-'exports onfyl Dale leaving U S. <br /> d'"i I-7 Tia aterAdnwAedgmeMaf RecelPl of Materials FAo,1yp_ Day Year <br /> Trensparlar 1 PrirrwTel`d Name S.7naVe <br /> Tra spnrter2 Prrnted'Typed Name r a _ ".1ontF Day vear <br /> ;`171Jfe <br /> F <br /> ?B.fhscrepancy <br /> 18a Dmaepancy Micahon SpaceQuanfRy ❑7'y p•e ❑Residue ❑Partial Re)ecI1011 ❑Fun R?�,zcLo, <br /> Manifest Reference Number. <br /> 186 Wk=l6 F9QW(a Generator) U S EPA 0 Numbe: <br /> J_ <br /> a <br /> Q Far9ld s Phone <br /> Month pay 'featW Sgrfature of Allernate Fr cgly(or Generabo <br /> Waste Report Management Method Codes fr e.codes for hazardous waste treatment.disposal,and recyciing systems) T �13 <br /> Z 3 J cQ n <br /> O <br /> 20 DesgwI8-1 F3S,trry Omer or Operator Geruf raiwn of receipt of hazardous matenals covered by dte manifest except as noted in Item 183 <br /> Printed Typed flame Signature hAanlfi Dal ean = <br /> Z] <br /> 8700-22(Rev 12.97) Previous editions are obsoiele GENERATOR'S INITIAL COPY <br /> cQ �I <br /> CD w <br /> Cn 00 <br /> O <br /> w <br /> 00 <br />