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Mbg <br /> R � a.Fa 1 of E106rpnclf Response Phone <br /> 4.Waste f r r <br /> $ 1.Generator ID Number �`� ✓' "' <br /> i6N41AUR®t*Us <br /> WASTE MANIFEST. CALf!'l� " c raves ndaresa(8 alRerert than malting aarha�� <br /> s.Generator's Name and Meiling Address et arjo <br /> T7 I L4 <br /> .. <br /> tacw)R U:S:.EPA I Nup� <br /> &T 1 Company Name _ > <br /> U.&TPAIDNumbOr <br /> 7 Trarrepotter 2 Co•� Name Nov 2' 2015 <br /> ^ : A ; <br /> U.S.EP ID Number <br /> S.Deeigitatad Ear ly-Name 'She P5 SerO16 -ENVIRONMENTAL <br /> J604), 6-tv `, -e L,ya.4 '. 1 M'DEPARTMENT <br /> tia::Corers 11:row 12.Bret <br /> aril s Ptmne` ; <br /> 8.Waste ShW q Name and Dasodp T <br /> 'N6. T Quanary: WtNd. <br /> } 0*i i <br /> 3 <br /> 13 Special t der>g Inslarcdone and Additional l 1iQ r Ivy 4 JP I f .fi leru-5e . <br /> meet are fully and accµrate�/described abode by 8�proper shaping name;and are dassiaed,packaged, <br /> t4.(iENERAT0E1'S10FFEROR S CEtiTtpiCAT�N thereby declare that the <br /> contents m this oortsign 1e Intemattdal and national�vemmeMal regt> Mh Day Year <br /> r condition for transpoR according to appUcaii _ <br /> marked arm iib sxtd are in as respects ro P Signature <br /> yes PdntWTyped Name <br /> Generato <br /> U.S. <br /> ❑Efrom pact of enb*)ft <br /> meM1s.. xpfrom <br /> f 5 Intemadonal Shp tmpat ro U.S. ., Data <br /> far.T:. j M Day (Yaw, <br /> of Materials <br /> cc' 16.TransNrter Acknowledgment of iecxipl _ <br /> Signature <br /> T edILYPad.N (E.(f Month Day Yar <br /> (S t ;.r Signature <br /> JUL <br /> Transporter 2 Pim W I yped Name <br /> Cl Full R* ion <br /> 17.DiscrepanCY Residee< i _t PatBai R*dw <br /> 17a.DiscrepanaY trdcaWnI SpaceDaaLJ TypeQuantity <br /> Mael<eat'Reww'ra Number. U.S.EPA ID PRxnber <br /> 17b.A1100 Facility(or Gensraor) . <br /> Month Day Year <br /> W6 FacByrs Phone.• <br /> 170 Slgriature of ANemate FrAty(or Ger ' <br /> sf5 F� <br /> } <br /> at materials covered by the manifest except as rioted in Item 17a t th /p�a,�w� yeu <br /> Cartiitca8on of receipt -« - <br /> 18 Oest�eted FadAty Owner or Operekx: Signature �_�. f •..^% <br /> Pdntedl(yPed'Narpe/,r i iRA �?ORTER <br /> iV #2 <br /> 169-BLC-0 6 10498(Rev.9/09) <br />