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y <br /> ease riot or Form Approved.OMB No.2050-0039 <br /> Ptype, <br /> UNIFORMHAIAR[}GUS 1.Generator 1D Number 12.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number 8389 Ir'+DD CC <br /> WASTE MANIFEST .I. .i�r,1';�r�ts F, 2 0 6:C. 2 L. B <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> AfJGUtf4ETT'l wMI)TIAENT'S LLC <br /> 8638 r:OPPEROPOLISRG' µlab 6-E6C.ALUIvE BELL01A RU <br /> 'OP-,,CA D5236 rAWAINGTGN.CA r;15230 <br /> Generator's Phone: U-S.EPA IU Number <br /> 6.Transporter 1 ComparlyName.,...:i.-+t:. Irl VALi r WAS :'::si., t�s CAf 000272'3C2 <br /> 7.Transporter 2 Company Name, c r :SO <br /> U.S-EPA iD Number MNSU[1U110924 <br /> ;�T�RIi�YGLE�I'ECIALT�V►A.r,TE:C7l.l.jTtL?NS, ItJC <br /> 8,Designated Faaldy Name and Site Address:1$7 C;E141(1R Y ER NT R f t�1TAi lt4Gl�I7[)F{vE1�AUA,f LC U.S.EPA ID Number <br /> N1IO98iir3£l533H <br /> "O tdElNiAfdi75 DR. rAalr <br /> rERNI-E'.f3V ^74nn <br /> Facilitys Phone: <br /> 9, 9b.U-S.DOT DesaipbW pcWng Proper SNpping Name,Hazard Class,ID Number, 16.Cantainers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No- Type Quantity WI.NoL <br /> 1- RU. NAA07—.riAZAAL OUb VVASTi-600 lit N 13..`r 4 10,111 GA.i t tNF r 111.11 165 F 0018 1Y)2 <br /> p rG1i1�qFi PtNtAPFIITr—RS&14')`tiFti ___ _-.-i_--•--._ <br /> uF <br /> u.t i <br /> i <br /> k <br /> 3. <br /> 4. I <br /> i <br /> 4 <br /> 14•Special Handling Instructions and Additional Information <br /> .—BT. 91-1 FRS,CTAS £RG#171 <br /> t_t-AFRGENC;Y CC4,JTACI'. RON <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassifrad,packaged. <br /> marked and labelediptacarded,and are in all respects in proper condition for transport according to applicable utemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,f certify that the contents of this consignment oonform to the term of the attached EPAAcknowtedgment of Consent. <br /> I certify that the waste mininvizatim statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(h){i(I am a II quantity generator)is <br /> GeneratoesWeWs Pnnted7yped Name Signature ( Month Day Year <br /> J 16-Intemabonal Shipments <br /> Ll <br /> lrapwt to u-s M Export from U.S. Port enbylex . <br /> Transporter signature(for exports only): Date leaving U.S.-17.Transporter Arknowledgment of Receipt of Materials <br /> Transporter 1 y Si Mont Da Ye r <br /> 7ranspo rtntedfT ame Sg re �at <br /> 18.Discrepancy <br /> 180.Discrepancy Indication Space ❑Tyles Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number, <br /> 1 Bb.Alternate Fadlity(or Generator) U.S.EPA 11)Number <br /> C3 <br /> tai Faatitys Phone: <br /> LU 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> a <br /> r <br /> 19.Hazardous Waste Report Management Met ad Codes(i.e.,codes for hazardous waste treattnent,disposal,and recycling systems) <br /> A 1 <br /> �[1141 2 3. <br /> 4. <br /> 20 signaled Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prince ed Name [ _ `' 5ignaluore MD <br /> EPA F 7 22(Pev- t7} P vious editions are obsolete. AS9NATED FACILITY TO PA's 0-MANIFEST SYSTEM <br />