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0=7777 <br /> onWaste Trackmg Number <br /> 2.Pa9B 1 at 3:Emargencq Fresporrse Phe <br /> 4 <br /> 1.Generator IDNumber <br /> 3 :9Crw-,* : <br /> }�ON•HAZAAQOUS R, <br /> W STE MANIFEST. Generators Site Address{f dilfesent than mailing addressi �. <br /> eneratofs Name and Mailing Address i ryf 1 <br /> {{ 5 G tiny 1, <br /> 71r=,,{d U.S.EFA ID Number <br /> Generator's Phone:' <br /> 6.Tra+spoiler t Company Name <br /> „ z kir'.itr;l; U.S.EPA ID Number r <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> ! 8.Designated Facility Name and Siie Addresslr ih i <br /> 'I ,:�.i=>;TF;�f�=?4tlit ��il,��t{1- ]I�dL• F � `1( ,! r� ��. <br /> t p5 P- ii( i V,:�r:iil.�s i°Ili: <br /> Faci4it s Phone: LT,' .s.,:"' 10.Cantalners ��t- otal <br /> Qua <br /> 9.Waste Shipping Name and Description No• tYP �• <br /> +M1 F. I Fes. r ri <br /> { °app <br /> Z. ;x ''h l�- f„]l,i`.7Y�i;il..`•`ir! �':17i"i i1- 4�«d'—2, es <br /> Ll <br /> I t. ;,,r�Pd�'sF'��'r,�ltl:I"t_t�",3 �,Tx; ,P , <br /> �iw <br /> 7, rz <br /> w <br /> - Z <br /> W 2, <br /> If <br /> ~ <br /> 4 <br /> 13 t3pacial ndling fnstnfcticns and Additional Informationill Z J01 <br /> • <br /> f wvr'; <br /> v`rPR01-,I:Riii';PfiLf-1Z-`-''2 <br /> }f 1q.GENEIiATOR'SIOFFEROR'a CERTIFICATION:I hereby declare that the contents of thfs consignment are fully and accurately described above by the proper shipping name,and are dassriied;padraged, <br /> marked and labeled/placarded,and are in all respects in proper condition for lrarispod arxarrpng to appficabie intemational and national governmWal regulations. <br /> G"eia`toesilo feroes Printedffypad Name Signa+ora _ + Month Day Year <br /> _j 15.Intemdonal Shipments rr' ai <br /> F: ❑Import ro U., l ❑Etcporki ,S _ Poll of entryfexil: <br /> IL <br /> Transporter$I nature for exports on ht ”r Date leaving U.S.: <br /> I cc ia_Transporler Acknovrledgmant of Receipt of Materials .% .. �.., "• •, v , <br /> Transporter I int€ilii ed Nameg ;? rgnatuYe, <br /> "Ir, �- 6nih ay Yeparr <br /> C Tran CA r 2 Pdntedf(Wed Name E� Signature Manlh`' Day Year <br /> - NO <br /> 77:I],streparicy, - "��` <br /> f�a,-yrs 17a_Dlsaepancylntl�Ca€ron5pace . i..s •. " � �� <br /> +p' ❑Residue <br /> En!Futi Rejection <br /> yz ❑Quanlriy ElType ' <br /> Partial React""an1 <br /> y <br /> " 17b1 Manifest Reference Number: <br /> 1 <br /> r rmateFadilly{orGerieratw) U.S.EPA'IDNum6er r1 <br /> FBCt� r d _ <br /> r <br /> - <br /> F � . <br /> ' o0-09rmture of Alternate F$ptity(or Generator} _ <br /> z Month Day Year <br /> ij <br /> rafdr Cerhitcatmr�of race€pt of materials covered 6y the <br /> Manifest except as notedinItem a <br /> s a <br /> ° � Signature? ,.�' Y arsZft a Ye <br /> 7€' <br /> N0 risPo�rER 2 t. <br /> - - 3x..srx..r,�.. rr w. '�, e .� a',4 � ,+�-r6�}r rrr!•117 c i 5A�tl..d��k':.;`. <br />