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D 307 N <br /> O AW O O C <br /> N o <br /> s Form APP,oved.OMB No.2050-0034 - <br /> D Please punt w type,(Perm desr rred for use on elite(12-pitch)rymewriter. O <br /> UNIFORM HAZARDOUS r"B"ezPapn tnl ].Emarggney Respnna.e Pt,-, 1.rWnNeslTrec7•iny Number ��� � CD <br /> D WASTE MANIFEST '' I I r. { ISP O D <br /> z _ <br /> n Generators N.,—.rnr llarn.:.a�i,�-es> ewneramrs Sna AAdress fit diaeranr mae mair+n9^anressi <br /> F44 lr <br /> CD <br /> IT <br /> = n�i <br /> 1 DN G <br /> Generalo:_ CD <br /> F Tre 5-1,, US EFA1rJ Nwnh� <br /> Q <br /> TransmR n'.�-.!\.".. A5 EPA IU Numbe! C= <br /> r..A fto <br /> U S.EPA 10 Numlter <br /> Y! N <br /> oti'^. rrt <br /> iaSplA � <br /> FaC m Iris Phare r` <br /> 9b US DCT Desrz:- .•"c��Gning Name.Haeard Class.IN Nurl 10.Containers ti.Total 12 Unit 1,3 Waste Cines <br /> Na. T Cuanlily WI NoI 3 <br /> HM ana-.,c Type (D <br /> 1; to <br /> cc r* <br /> O r O <br /> z N <br /> W V <br /> U5 01 <br /> U5 t,p <br /> u"I <br /> N <br /> I � <br /> r� <br /> O <br /> r(D <br /> iL gp,•.; - _._.-'�nns and Addi7onal r Inlor ,,,,O <br /> . fD <br /> Q <br /> 1 <br /> r-r <br /> 15 GENERA70R'S+OFfEROR`5 CERTIFICATION: hereby declare that the contents of this consignment are Sully and accurately described above by the proper shipping name.and are el I am Ir packaged. 0 <br /> marked and labeledlpiacarded,and are m all respects in proper condillen for transportaccording to applicable inlematonal and national governmental regulations.Ii exportshipment and I am she Primary O <br /> It <br /> Erporter.I car*that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent,CFR 262 v <br /> Month paYear Q <br /> I certify that the waste minimr2aliort statement identified in 417 .27{al Gr 1 am a large quantity Signature or IGI(i4I am a smalV quantity generator}Is e. y <br /> rD <br /> Ge<terator's.13,f8rors Prinled+`ryped Name vt <br /> l7Q <br /> ❑Export brim S. Porof e <br /> 15.Intenational SnlpmenlsEl . <br /> r-r <br /> N <br /> Import to U.S. Date leaving U.S.: <br /> (D <br /> Transpolar signature(for exports only) Q <br /> ment of Receipt of Materials Mcntr, DaY Year n <br /> Re 17.Transporter Acknowledgment P Si nature O <br /> W g <br /> F Tanspo te-i Pnrdedgyped Name <br /> 7 _ Month Day Year <br /> i Signature <br /> n <br /> ZTransporter 2 pnnledfryped Name <br /> a <br /> Y <br /> Residue rtial <br /> Ra}ec9 on <br /> 18 Discrepancy ❑PaRejec6ar ❑Full❑ <br /> 1 Era.p}spepgncy Irldlcairon Space ❑ 4uantiry Tye <br /> Mar lfesl Reter8flbe Number. U.S.EPA(0 Number <br /> 1$0.Arlo ateFa)*{or Gerrefatorj <br /> i <br /> � Month Day Year <br /> Facslih/s Pflone ZJ <br /> 19c.5 gnattxe of A+temala Fly(Dr Generator) CD <br /> O 0 <br /> O <br /> y,�Codes(ia.,modes tar hazardous waste trealmart,disposal.and recycling systems} 4 <br /> v Q <br /> g.Hazardous Waste Rii Man W"Iltu 3 <br /> a 2 2 <br /> th year <br /> G bon of retarpt of hazardous toalerials covered by Sha mashe51 61tC8Ql a$rtclad m Ilem <br /> T 20.Deslgrawleror <br /> ledFwIrlyoOp SW- Signature o <br /> Ptm4edrTyped Name <br /> 1 <br /> GENEELA `Blti <br /> CD N <br /> N CY) <br /> ot Form 8700-22{Rev.3-05) <br /> Previous el are obsolete. � <br /> W <br /> 0 <br />