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Please print;or type.(Form designed for use ori elite(12rpitch),typewrlter,) .: Form:Approved,OMs <br /> UNIFORM HAZARDOUS <br /> is t;en�r�ator,IDN�mr '; t 2 Pagelvf 3 EmergencyRespoise�honei. NtanretT KjrgN b r <br /> WASTE MANIFI=ST t, 1:. " <br /> 5.—G onefatoi4s Name and Mailing Address Generatoes Site Address(if different tharr r4ling address) <br /> j. F N <br /> Generator's Phona. <br /> 8 T,rartspgrtertl Carni ny Name Us EPA,IDAwmbeG t�s' <br /> 7 Tirarsportr r 2 Company Namet a I ! US EPA ID Number <br /> S DesignedFc(ltfytame�and SifeAddresT L;-g.EPA Ibitp]6e <br /> Facility's Phone <br /> ga 9b:U S DOI t7esanptEon{ir cludmg Frpper Shipping Name Hazard Glass ID Nurhber,:: 10 Cortamers 1S TAtai f2 Un3t t 1sryasfe Codes <br /> HM aril Packing Group(if any)) No Type QuantEty WtJV0T <br /> 2 <br /> LU <br /> {ti <br /> 3. <br /> 4; <br /> : t4�pecjel,�Handiing instructions airtl Apolt[onaE Infomrahoh <br /> tJ.- <br /> J. <br /> 45 OEN..ERATOR S10FFEROR S CERTIFICATION I hereb declarehatthe cogtents of thls;consignineht ark fully and accuratelg described above by,tEie:proper'shipping name;:and era ciasslfied packaged, <br /> M <br /> and labeledl lacarded and are(n;al!res ects'In yre ar condltlotifortrens drt acCgFdln to a �lldable International antl':nat€o6l ovemmental re iilallom1f ex art shl ment andl ain tne.Primary , <br /> P P p p P 9 Gp 9. 9 P P <br /> ExpdrEer I c-jN:that the cvriienis of this consignr eftt conform to the terms of the attached EPAAcknowledgmar t of Consent,.° <br /> i ceYtliy tfFat the waste minImizabon statement idenbfled in 4D CFF{'262 27{a)'(if I am a large quantity generator)ot.(b}{if I�m a smati quariE,ity generator)Is true.. <br /> Generator sl0f{erors Pr3niedlTypedName ,a Signature a,t Mori Day Yesr <br /> �-18 fntemational Shipments <br /> ❑Import to U S ❑Export from'li S Port of entryle.At. <br /> z` Transporter,slgpafelre(forsxLU <br /> ports.only} '1 ; DateaeavEngUS,: <br /> 17 TransporterAdmowlo�gmertt�f;FkeLptof� latenals , � <br /> Transporter 4 Pnntedjyp%dr(J 3 c k Signatutet + P mono Day: Yea(' <br /> Signature , <br /> 2 Trans oiler 2 PnntedlT ed Name � '� � ,( ' f r� � "„'w �, ' M n�? Dat Year ' <br /> t <br /> Yp . � l2 <br /> 18 Discrepancy. _. : <br /> 18a OEscrepancy Indicatien Space Ply. TYPO El-Full RejectionR <br /> Manifest Reference Number <br /> ,. 18b'A tamale Facility(or Generator) — U.&EPA Ila Nufribi r <br /> 4: FacilitysPhone <br /> Lu 18c.Signature ofAlternate Facility(or Goneratvr) MontYl Dayi Year: <br /> -M Hazardous Waste wort ement Method Codes:i e codesfor h#2 Mbuawastetrga` <br /> invent disposal <br /> u>> •_ :. .,. . . . . , P 9 _ .( and refiyrcling systems) . <br /> M,,1, 2, 3' 4. <br /> 20.Dostgnated Fac ty'owner or.Operator.Certifieat'fon of receipt of hazardous niatenals covered by the manifest except as Wd in :Item 98a. <br /> Printed/-Typed Name Signature. Moritir Day. <br /> EPA Form 6700.22(Rev:3-05) Previous editions are obolete TR4 S <br /> ®P1���� : <br />