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Piease.pnnr ar Eype;'(Fpr( des€gnedl44r;ttse on elite.(12-pllch).iypeWrlter.) Farm Appraved.,QMB Jo.2.50;0 39 <br /> IF- <br /> L <br /> A7AROt7U5 1 Generator tD Number 2 Pagemi o 3}Emergency Response Phodg 4 Manffeat Traeking Humher, ' <br /> ANIFEST .` : J. <br /> 10269 ®lamName apd Mailing Address: *_­GenaratoPs Sife.Address(if.d'dferent than.mailing address) <br /> r "TN Un <br /> ( TU <br /> � £e z :CAW-7-620 <br /> eneratorsPhoite: - i <br /> 6.Transporte?1 CampanyName U.S`.`EPA ID Number- <br /> PWIN&CUSt 100.6766404 <br /> 7,Transporter 2 Compahy Name U S'.EPAfD Number, <br /> Endue <br /> 8 Oes.Igna€�d!acility Name and SiteAddress _ U 5 EPA ID Number_ <br /> Tim Fwb",Wip(� � -, -- -. �. .._, — <br /> `p. % . E <br /> FaaililysPhone: -_ � • <br /> 9a. 9tr.U.S.DOT gescriplion'(including Propet Shipping Name,Hazard-Class,ID Number, 10.Containers 11 Total 12.Unit y3.Waste Codes <br /> HM .and.Packing Group(ifany)) No, Type. Quantity WI.Not.' <br /> e ( .� .H. 1157 `2 <br /> F <br /> :. <br /> Z. <br /> 1 14.:Spacial•Hantlling lnstructions.andAdditional tnfofmaticn � <br /> _ -� - <br /> rr� — - _ <br /> UW <br /> 15,-•GEN RATQR'SIOFt EROR'S:CERTIFICATION::I hereby declare Ihatihe'mnlenls pf this consl`4nment ars fully and acc>Irafely described abo0e by the proper,shipping marrie,arca are classified;patkaged <br /> marked.and fabeledlpiacsrded,and are in all iespactsin proper condition for trarispoif"accordfnglto:applicable infemational''ind nalional.goverrimental regulalions..lf axpod shipment and I.ami the Primary <br /> Exporter,I ceriifythatlhe cements of this consignment conform to the terms of the al(ached EPAAcknowledgmant of Cpnseni <br /> I cerirfyfhatihe waste;mihimization stalementldenti�edin 40 CFR 262.27(a)(if t am aiargp quanfitygen erator)dr,(b)(€(i atn;a small"quantity generator)is tnie: <br /> GeneratorsfOlfe7oPs Pnntedlfyed Name Stgnatuie, a Month Day Year <br /> eel <br /> :a <br /> 1p.-I ternahonal Shi Tbnts- r <br /> F- n p ' ❑Import to U.S. Export irQrrr U S -.Poii,pf enhylexit: <br /> Transporter slgna€Ura{far eXpoiks only},., Date leaving U;S.: <br /> _", � 17 TraiispoderAckn4w(edgment_bf Receipt,of Matenafs'.:. - _ .. <br /> Transporter 1 P�niedITypgd Name Signature Month Day Year <br /> Transpisriar 2 PHntedlTYpetl Name ' T Ilk <br /> Signairlr'` _ Manih Oay year`^ <br /> 18,Discrepancy vN. <br /> i8a.Discrepancylndreahon Space ❑.;Quanh `'�T L1 <br /> Residue <br /> ❑Partial Rejection ;❑Full Re action <br /> h "" YPa <br /> j <br /> ManifestReferenceNdmber..:_. _,_..... <br /> 186.AlternateFacili€y`(orG6ierator) L1.5 EPA'It}Number ' <br /> tai Facility's Phone: <br /> Bc.Si natuYeofAtternaleFacili for Month t3a Year <br /> 9 Facility ) , y . <br /> z <br /> 19 Hazardous Wasle Report Management Malhad Codes"(i.e.,code$for.hazardous waste tiealment,disposal,and reoycI1,4 yslems)` <br /> 40 <br /> 20-Des..ignated Facility t7alner tin Oporar Certification of receipt of hazardat7S inaterals tv'v"e�od by lFta:riiamiest except as tided in Item 18aA+'" F r <br /> Pnntedflyped Name. F kj ' ry Signature F . {`- Manlh t)AY� <br /> [ .�� :•f .I/ - a<, . f r "*���fi'... t �.�.- .E ' <br /> EPA•Form8700-22,(R6vA-05) Previous"ediGonsardobsale(e. t�+ { f3 (G ATPP A�{(cif YT®GNf -Gr <br />