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e,3 <br /> O05 6 22 a 8 9 SK 5 <br /> 50 <br /> Please print or type.(F=designed for use on elite(12-pitch)typewriter.) Form Approvocl,OMB No,20 -0039 <br /> ID Numbet 4,Manifest Tracking F! <br /> 'AD9824 <br /> UNIFORM HAZARDOUS t_Genera"" 00 562228 <br /> MS'M MMIFEST 9 SKS <br /> rdT -14 "ili- ?711V tate' rl m L r,e <br /> 20 4 2 r-,2 10 <br /> Generator's Phone, <br /> 6.Tq <br /> U.S EPA 10 Number <br /> 7,Transporter 2 Company;;Name U.S EPA IDNumm <br /> to kdrpss Sof ETY-141-EEN `YS1 Ell 14L US EPA iD Number <br /> 6000 88TH STREEI <br /> Facil, s Phone, <br /> 96. 9b-U.S.OOT DesWpUon(including Proper Shipping Name,Hazard Class,ID Numbee, 10,Containers 11,Total F12 Unit 113,Viiasla Codes <br /> Containers <br /> 't <br /> /Va, <br /> HM and Packing Gfoup(if any)) -N, Type Quantity WtAlbl, <br /> --77 <br /> 77 <br /> T <br /> (AQUEOUS BWE CLEAHV") <br /> LU <br /> Z 2 <br /> LU <br /> A. <br /> I A".3 *7 16-6"r, I"1t <br /> ,-4 HR EMERGENCY 141-800-469-1760 (SK TH', <br /> oWTH AS "AGENI-FOR" PY GEN TO RETAIN LICEWS�E[i SUB CARRIERS AS NLCFGSAR� <br /> 7- <br /> GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately desonted above by the proper shipping name,and are classified,padaffecf, <br /> rairdied and isdedand ate in al respects in proper ibon for transport according to applicable internatioraland national governmental regulations if export shipment and I am the primary <br /> Exporter I oed4 that Me contents of this owAriment conform to the tairris of tha alitachad EPA of Consent. <br /> I oed4 that the waste minimization s tementoentifteclin4OCFR 262,2T(a)(IP lamai"quantity g7en*era,,W,)or(lb,)(Riamasmliquanfityg,,Onerat lis quantify <br /> It re Llonlb Day year <br /> yped s4iiinal fe P .0 <br /> IV 1/6 <br /> U.S. P, 4 V <br /> International Shipments 4rV <br /> 0 I.pr,to U.S ❑Expon from SPort of ecaryle <br /> Transporter signature flat exports only): Date leaving U.S,: <br /> 17-TwWrter Ackricarledgmal of Receipt of Material. Wirth Do Y, <br /> Tm-asMw 1 PinniodfTyped N "graturre <br /> I b I <br /> 0. <br /> Z <br /> MonTranh Day Year 2 Pordle0l d-NaNam <br /> ype <br /> ivy <br /> 18a Discrepancy indication Space [I Quantity ElTyp- Residue ❑Partial Rejection ❑Full Rejection <br /> Manittet Reference Weber; <br /> 18b.Alternate WAY(or Generator) U.S.EPA ID Number <br /> Ivilon1i Day ye, <br /> 19.Haziirdous Waste Report Man Method Codes{i0.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2, 4 <br /> T, .141 <br /> 20.Des9whid Fadi Owner Or OPMV:Cerci tion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> dote St8s Ray e <br /> "ama <br /> EP 7 <br /> ea,�Wsedftts are obsolete. <br />