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Please print or type.(Form mete for use on elite(12-pmt)typewriter.) Farmproved.OMB No.2050.0039 <br /> UNIFORM HAZARDdUS 1.Generator ID Numb 2.Page i o! 3-Emergenry spons Ph 14L i6yt c �� <br /> WASTE MANIFEST - , n u 7 6 2 1 <br /> 5.Germetor's Name and Maift Address Generator's Site Address(ddllhered thin making address) <br /> Nbutiiiiiiiiiiiii-i-Cao.sum- <br /> Generdor's Phonv <br /> B.TreMwwr 1 Company Name U.S.EPA ID Number <br /> 1 $ a•i: a plow= �2 <br /> 7.T e US EPA 0 Number <br /> 4M vwcn <br /> a rested adltiy Name and Site Address U.S.EPA ID Number <br /> �Fliwallaw Does tib -. <br /> F 6P- ,.a'a nv•° <t'rx.''h' ,�,-9" '4, .�•'. :e -. - 1 S ` tE-' :b - ��lF O <br /> lie gb.U.S.DOT Description(Including Proper Shipping Name,Hazard Class.ID Number, 10.Canildnam 11.Total 12.Unit <br /> and Packing Group(d any)) <br /> MM N0. Type Quantity WtNal. 13 Waste Codes <br /> W— 1W-'L-3Rjj*A=VMjjjBrW >_ 1 <br /> oVA 150 <br /> 74 777 <br /> P <br /> nut V <br /> 1 �D <br /> wa•q . r <br /> ' �,.• v 4'9G. <br /> 717-7771751!7'.+. . ,:. y y Y aeik' A''a0...e` k- ':+(Lor A` Y'-�♦ t <br /> 4:R T"' <br /> fi Ct, o j <br /> I n=Yt, �9. P"- i.a,s; fp. ..yi R N: <br /> 0 <br /> s n i Dorsa n <br /> .4_ <br /> 15. GENERATORWOFFERORIS CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately desdmbed above by the pry shipping name,aid are classified,packaged, <br /> marked and Ybeladfplscarded,and ate hall respects in proper condit ah for transport according to applicable krtamallonal and national governmental regulations.If export shOwl and I am the Primary <br /> E*orler,I car*that the cottons of this consignment eorforrn to the tentre of the attached EPA AckrKWedgrnerd of Consent <br /> I certify that the waste minimization statement k"Fed in 40 CFR 262.27(a)(d i am a large quantity generator)or(b)(III am a 4 1 q ly gene r)is 44 <br /> Gener rot's f� n Signature Men& Day Yew <br /> i� <br /> 17 L& <br /> 16 n ❑Import to U.S ❑Export ttom U.S. fort of ent vhWt: <br /> Transporter signature(int experts-W: Date leaving U S:. - <br /> LLI17.Transporter Acknowledgment of Redxffpt of Materials <br /> rter Pdn ypad Nene UNZ 15 <br /> a <br /> rn <br /> a Pdn me MM% rain <br /> 1 <br /> * 18.Discrepancy <br /> 111a.Discrepancy hgicahon Space ❑ Quanfdy ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Referrmce Number. <br /> tab Alternate FaclRy(or Generator) U.S.EPA ID Number <br /> c� <br /> tai- Facility's Ph" <br /> o ft SIgnaturs RAfternale Facifty(orGenerator) ®larltle Day Yam <br /> CD 19.Hazardous Waste Report Management Method Codes(c a.codes for hazardous waste treatmerd,disposal,and recycling systems) <br /> n 1. 2 8- 4. A <br /> ]5-2 <br /> Ron , <br /> 20.Designated Facility Owren ar Operator-CeNScahrm of nxeipt of trazardous matenais covered by the manifest excV as noted v Item I Be 1 <br /> �! d Signahtre mgm Il�sr <br /> EPA F B •22(Rey 3.05) Previous ed ns are obsofe QES HATED FACILITY TO DESTINATION STATE(iF REQUtR{EED) <br />