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M I 1 0 'a - � <br /> oom 2 — m <br /> Cn CO -Cp -qW O <br /> 3 � <br /> OCY) (D — N <br /> O 00 (0 CO CO <br /> M. C94 � <br /> O r r n N <br /> mmr; w <br /> E o <br /> f <br /> C/)� 00 <br /> .- Please prml or type.(Form designed rot use on elle(12-pitch)typewriter,) � <br /> UNIFORM fiAZAR00U5 t.Generator tp Number r.'-"r � °;<s;;.f, O O) CD <br /> CD (D <br /> 1,PeIle1�1 r Crmrvency NnepdMe PhOAe <br /> WA5TE MANIFE57 "G°'W <br /> 6.GenMalor's Name antl Melling Address VV 9 FLE;.^ 0 .--r serol a Iq reser rmanmee.eg,�,1r.,,. 00 O (D <br /> va -2 3 <br /> Generators Phone (n CD CD w <br /> 6. ranaperter! Ompany Name CD � (1) 3 <br /> 7 Transpnder 2 Company Name :7O Q P <br /> r- <br /> 0 n Q <br /> G) < n <br /> Faciliry's Phone: 0Co <br /> 3 D <br /> ga 9b-U.S.DOT pascripfion(IncNtling Proper Shipping Name,Haxartl Class,Ip Numher, (.J '••� <br /> HM and Packing Group of any)) 1d.Cprnainers !!Tnra Co <br /> O }. No. Type Cuanliiy N•..r�� =-c. 1 <br /> CD <br /> ¢� v O <br /> K Q 71- <br /> = 2 O N <br /> [7 3 0 <br /> 3. (D <br /> O <br /> � O <br /> 3 <br /> 1a Special Handling Ins]ructions andAdditional lrtformation C <br /> 3 <br /> O <br /> I& GENERATOR'fad!,EROR'5 CERTfFICATION:Iheredy dadare that the cvmm�ls of this consignment are full and accuratel described aboveb the o <br /> ► f' mpa,te,arid laythat the Cal'an and are in aft respects In Proper condition for transportaaoming to applicable imemational andynalional governmental regulations.Ilex <br /> Expvdecicedify tharthecontorts ofmis mnsignmentconronn la the terms afthe attached EPAgcknpilGaW Mena Consent. shipping name.and are cias5fierp.pagy N <br /> f certify that the waste minimization stwemem identified in q0 CFR the ter lay(If e a a lar a Paoli Pon shipmeril and I ao T.P—_, <br /> Generaforsl0 stars PrinfedlTypatl Name g q ry generator)or(bJ(if I <br /> gna Pre am a small quantity generator)rs true. <br /> iO <br /> Q- <br /> 16 Inlemafional Shipments 'o. ea• C <br /> ? Trans oder 51 nature for expurtsonl)Import to U,S. <br /> ❑Expan from U.S. Pan of enlryiexil _ <br /> w }7.7ranspraderAcknowledgment of Receipfnf Matedals Dale leavin U-S.: <br /> Of Transporter f PrintedlTyped Name GO <br /> O <br /> m rgnalure CD <br /> Q 7ransporter2 Prime typed Name f "a} "� <br /> ignalure N <br /> 3 <br /> 18.Discrepancy CD <br /> fro.Discrapancylndication Space ❑ K Guanlily _ <br /> Type ❑Residue <br /> ❑Partial Rejection C' _ <br /> Y <br /> F 78b.Alternate Facilily for Generator) C <br /> _� Manifest Reference Number <br /> ca U.S,EPA ID Numher <br /> Q <br /> a Facili 's Phone: <br /> C3 <br /> 18c,Signature ofAltemate Facility(or Generator) 3 <br /> C <br /> z � <br /> f9_Hazardous Waste Report Management Method Codes(ie.,codes For hararddus waste U MMIh Day 07 <br /> rn Yea- <br /> W t <br /> n Batmen},disposal•and rec lin s I V) n <br /> 2. yc 9 ys ems) O <br /> 3. Q <br /> 29.Designated Facilily Owner or 0 q O <br /> peraloc <br /> PdntedRyped Name CerlifcaU'on orre p (D <br /> cel t of hazardous materials covered bn <br /> y the manifest except as noted in Item 18a 3 C <br /> Signature O_ <br /> EPA Form 8700-22 jRev,3-051Previous editionYear s are obsolete. D <br /> Month pay O O <br /> � I Cn <br /> Q = N <br /> GENERATOR'S INITIAL COPY O N Cao <br /> � r <br /> w m <br />