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X75 / <br /> ,rrt or�wm rtad for use an eats i2 llch r. 1275414 <br /> t.Gf r use Numbw 1.Page 1 of 3.E Forth roved.OW No.2050.1�t9 <br /> UNIFORIN HAZAROOU3 merpW sj=oa PWw 4. Tmlcfnin unbar �+ <br /> WASTE MANIFEST _ O O ( 0 7 4 6 JJK <br /> SGena WsftmeandMWMAddress. AddrMR ommalangammes) <br /> Hwte Repel C/Q fu rtte. Hae Repot CSR MN SENT aim <br /> 5151 Sm Felipe ME REPOT W1116 151 Comm AE <br /> Qmdbwtn ( 6 - 314J aim ca 1513i (20125-1111 <br /> S.Transpor(p 1 y Name .8.EPA W Number <br /> 31 <br /> 7. rensporfa2 CorrrpanyName U.S.EPA A Number <br /> 21&t Can+ <br /> 5.Deaigm&d Fadlity Name and Address U.8,EPA ID Number <br /> 6ENW ENAAL R61, LLC RIA PSC ENNJIMMENTAL SEWcEs <br /> 11155 VRIE w 1881 <br /> Fa jtffJ. MM <br /> ger, 9b.U.S.DOT De w4*n(Incki tg Proper Sttippllg Name,Hazard pass,ID Number, 10.Containers 11.Total 12.unit <br /> 1gg and Paddrp Gro+P 0f qA No. Type OAnthy WLNd, 13,weals Codes <br /> ci. NX41A I NZAROM PASTE LIQUID (INTER 90 PMWTS# 291 <br /> t <br /> ILD� l P <br /> a 2' tolig r HASTE REWAS, RAIMRI 2.1 *T--5P-# k RQ11117-191 8111 SOM Darr <br /> f DF p <br /> 3' Ig1t993 PASTE fIAlN1AEE LiAIIIRS, U.S.S. (Rt2:TAlE, (EINYI EINYL ,jam' D1r1 DR35 <br /> Ra KETONE) 3 P611 (FIASMEWT41.180 RQ(Drr1=lrrl 41ff p <br /> 4.OpecialRudng ln&kC&U 001&7m tng7m—ft z' <br /> (2) 2.1-11 - (126) S- TIQ (3) RM-8i - E46(129) FLMRULE <br /> LOOSEFF4.( R: <br /> 15. GENERATOR'BioDFFERMS CERMCATIPN:I bemby dedam Owl Ute c nh*of this wrrolpwo$fd ere r Orld 60own1 iy described above by fire proper shipping nems.and ane dmdllad,pedmpd, <br /> merited and labete*lacarM,and am in all map"in proper wrAW n foroaneport 00wd%to4V0oeble and mkwW govanvnental mguk*=.tf aMW M*no t and i am the Pdmery <br /> EJVoda,I oarlify that the omtleofs of this cortstgnrrard wnlbrm to Ute wm M Ore attadred EPAAdmwkdgnem of ComenL <br /> I arUty Thal the wane mWmbaft steternentideeMad in 40 CFR 26227(a)(111 sm a large Quarsaly genwvW)or(b)(UI am a wd quanthy gsnorpla)is oue. <br /> Generators/ONrofgPmt�ed</lypedNeme /1 Spnepaa Moo Day Year <br /> nterrmtional ids z ((��--lt❑knpat to U.S. LJ Ev d frau U.S.. P W enbyma <br /> TramWef she(kre anh'): Date leaving U.S.: <br /> 17.TiarwportaAdetowledgnmttofReceiptofiAs0arl* <br /> Transporter YAC Signature mmm Day Yew <br /> ran3poner sow Mort Day Yew <br /> M Dbmpw&y lit <br /> 19a.mcrepan y hnftvon Space 1:3 Qm* ❑Type ❑11e8(dr!e ❑Partial ReJecnon ❑Fua RO*O. <br /> 1gb.Meraate FecSdy(or Generator) ardfest R N <br /> cr�ar U.S.EPA ID Number <br /> .4 Fedi Phone; <br /> 8 18c. re o b ty a Ga ore Day Yew <br /> ti <br /> 05 19.Iwardous waste Report hlenagenrrerd ftaetlrod Codes(ie..codes for hazardous wage beahmK dwpoaat.and Mgdng Syst8M) <br /> R 1• 2. 3.Ir36 4. <br /> HI1I N111 N141 1141 <br /> 20.Desigrtabed FtWay OmAr arOperata:Caftafbn of n3osiptaf hezardow materials covered by the meAifnal ma-'as noted in Nmn 188 <br /> 8 MWEear <br /> EPA Form 87D. (Rev.3.05) Previus aIIIWlI9 are obsolete. <br /> DESIGNATED FACILITY STINATION STATE(IF REWIRED} <br />