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Droved,�n <br /> Drovers U.',F€0 No,C 5_ !'3 d <br /> Please print or type Rerpcn e Ptonv 4.4AanNestTracking Numb <br /> $ Generator ID Number <br /> 2.Paga'=at 3 En ergency UNIFORM HAZARDOUS � � <br /> 01365 1 <br /> WASTE MANIFEST _ � _H <br /> nera;oes Site Address{d di8cs'enf fnan ma tin a res; <br /> 5.Genontlor's Nave and Martina Aodras3 <br /> Gene. tsPAo U-izz€At�1N mSer - rr� <br /> t°s Tratssooti1 Campo Na <br /> �d mme �- <br /> l. Ua`. PAtt}N rrter• <br /> 7.Tra IpOA r 2 nPRr.y _ <br /> „r4✓ '' L.€, Lv t f;},'e ` ..CC P:.^y �t,�+e"ui{s -2+tjc jun <br /> jSEPAr�:.r8.Designated Fa Arty Name and Site Address <br /> Yvacuity s PhoneSh Na e,}€aza:d G asstG Nurnr ? r t 9txUS Dt6tvtuctinProper Ppi it,'.1. <br /> };{4 arsd°iN.Y'aF„f`iro'sp'r`aT9y'3 <br /> r 's <br /> J j <br /> 8 <br /> 14.Spjal Hanst+rq instruaiars and Additional lnforrnMiGn . .. .. <br /> 15. GENtRATOR'SIOFFEROR'S CERTIFICATION; €herotrf <br /> it re tai the contents of this mrsigrnment are fury and acs ately des r a a ve by the proper shr p n nom.are 3,11 a a cd i a ed: <br /> txrchbon fir transpm+acccud:ng to applicable internationaiand national govermn ntaf recjnta[m�s It export shipme_t aflu i am t;a p snafy <br /> a reed a u3 rata led p#aosr4ed,and are ars all respects€n proper <br /> Expo2er,I cetify thatthe contents of this GmsYgrimen!Oonform to the terms of"gladte4 EPA Acivtow.edgmmrt of Consent. <br /> I certify that the waste m irnizaticn sta•.ernent idemified in 40 CFR 282,27fa)(4 I atm a targe quantity geaeraori car(h)(4 t am'a sma E rrua"V genarahvj s t ue. _ ;r'erre Gay Yea° <br /> tenerato€'s!O9fefors t-,0ypedNorne 1, Sg� <br /> 18,Im€enu3t�sa Sirp'."s LJEx €Efrain U.S. Port of entryex" -_.-_...... <br /> 1mpcR to V& Date leavmg US,: <br /> lrans4olUr sl,natufe(for axl'MAS city): <br /> 17.TrarLWiaderAclmasredgTo-rit of Receipt of M21tfrials <br /> Gay Y <br /> ,.t =tn�cdit <br /> Transprxrter 1 Printed 3yped Name <br /> 0 <br /> Cray Yea, <br /> Trarrsp0rter 2 Pnrla&Typei tie <br /> gr' r7 1lieJ <br /> 18.Discrepancy <br /> 18a.D°scree y ind�:xL Space Type Res" <br /> Pa Ua=Re totem 1 Fuc Re esti <br /> t� Ouaniity <br /> Manifest Referenoe Number. <br /> U.5 EPA tOr Numter <br /> 1 ab,Aiterrraat Feat(or Generator) <br /> Facility's Phoney W111 Gay Year <br /> 188&gnat nE of Alternate Facility(or Ger Par) <br /> LLJ <br /> 15-Hazaracus iiVeste Report Nbriago rpt Method Godes(i.e.,codes for nsazardo s waste treatment,disposal.and Ma Oirg SWO") <br /> T__ <br /> LU S n <br /> 28.Designated Facility Owner Or Operator:Cert ficat€o o€receipt of haza�atfs rtaterrals covercd by the manfest except as noted rm i1e n 1$a 7o71 IT'iY„ar <br /> Printedlfype4 Name S g mature <br /> � 51/ <br /> EPA Farm 8700.22(Re+.12-1 ) Previous editions soteie. <br /> BE I"''i , t}#���Y 3aY 1 ��A`Wec .;.tis°;, r_�s; s '.5,i j;; <br />