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<br /> IlNIF.OR R66u5 Generat&fD Number f 2 Pape 1 pf 3 Emergen4y Rosponse phohe' 4.ManifesCTrackir�g Number". p��(
<br /> WASTE NkANlFST ' r f. ',- F OO .' . ': .' .. .Ut'►
<br /> 6:i3enerafdr s Name and Halling 1lddress 5 Gerrerafors-BlteAddress 4if difterent:lhan maikjng address);
<br /> VA
<br /> Gegafafdr`s Phone: R �i:' .
<br /> 6 Transporter i Company Name
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<br /> tl:S EPA
<br /> 7 Transpbrter2 CompanyNang - rZ ! U IR hlrirdtier 1
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<br /> S pr s'gna ed Faciii 'Name`and 511eAddres&" - - - - : ?�: Alb RCIj i'
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<br /> CA
<br /> Facilfry'sPhane � � - . .. .. f�CllJj:J -. :'• :, '- -
<br /> ga:',9t:U:S.:I70T[l�scnpaorl(friclud`irig f rdper Sktippfng Name;Hazard Clbss,ID Number Q.Comaloers Total- f2.�lnit Waste Codes:
<br /> andPackin 'Gran ;ifa i' uanfit :Wt./VOL '
<br /> . ,. ,g ..P( : yf) Np: y}te Y r d
<br /> LU
<br /> OWN.
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<br /> Speatal�HafZdd��ng,tnsfrucfrptisaniiAdddronallnfermaton•FFFFaaaa !!��.g��,ya; - ,• - •. - i
<br /> 1- 1. '",- r..y�:tl 1 -'r 'V'...iw 'E.' .,, _,.:.�. .}�,-51- i i,• 'kAY�]�,
<br /> (SWUSS H2
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<br /> _ :9'z:;GENi RATOR'SIOFF ROB'S CERTJVjdATfbN:'I hereby decrarelhal the C6n(enls of lttis consignmeniare fuilyand accurately descdbsd above by ifie proper shipping,riarua;atrl:are classkf;ed;packagetl, :
<br /> P - Marked and,iplieled[piaCarded,and are in all respects ingfop6,wndNon forfransport accbrdirig to applicable in a�_atienalarid naligrial oK?rnmwal'regulstlpns.If export sfilpment and l arh the f�nmary
<br /> Fxpo'erf-certify.giatthe'contenlsoflflts.cansigrimer?iconfa�intotfi afortns'bfffreaftaclt@dEPAAcknowledg riloi'Consent;
<br /> lcertifyllratiliej ante:minimlzationatatemanfider111fipdirj40,CFR2 2,27{a}'{lfkama[atga.guant(tygenorat r)or.(fit(iffa asmaff uanlilygerie�ato1isAJrue, t,
<br /> GerjeratorslOffero PtintedlTYPe Name ,,vv! sign�dfe Day Ye
<br /> r;' Olrportfo U5, �xport'frarrf€J,S:'' ;'Pbriofsnlrylei:`
<br /> ?' Transporter stgfratuie,{fb'r experts oris :,.• f)ate leaving U
<br /> raC-17r;Trdnsport@f,Acknavifddgme�tofReceipjo(Materials
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<br /> ,Transpod$r-!'Ahntedf€yped Name :` ,�t� :.: Sigriaiure : :Month w qay: Year
<br /> .Transporter 2 PnntedlTyped Namef ?. `: Signatdre ivlonlh,. Day'` Year
<br /> ,18,Discrepancy '
<br /> ;1$ati Drscrepagcy Indication
<br /> 0-Quanjlty ;;.-,. 0 Typa L� 'PI U01- P,ar6at.E2ejecfion' Full Rejection
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<br /> MJ hast Reference dumber,
<br /> f8a Alkeiaate Factiity-(or.Genaratof)' , L(.S.EPA 1D Number'
<br /> FeciliVs Phone,
<br /> t8o Si Rature,ot•A(tefnate,Facilily fol'Generator]::. -
<br /> � .. Mon(h' :,Dai;.-':Yea[:.'
<br /> 19 Ffaa'rd5us Wasla Report Harsaemanj'Nfelhod Codas:(I.e codes for hazardous waste treatmegt,dispasai,and recyc(!ng systems}
<br /> i '„�• tom. - - . .�z:"' -
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<br /> 0 D I sled acf$t hero`G"sr or.COhonafx eef'.1` -aiard6usrii t tialScover rt6.lfiema'3festeXce to 1#edldltein:l8a : ;` ''=.'
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<br /> ,�'frnfedff pgd Sunature :6 P. l Yea °fi b
<br /> SPA i arr8 87Dp 22(ttev f2 17):Previous editions are o solete '.~" `; �NA
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