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_fir n r;i;_ptDvs;d.UF�{I3 No.7.050•pt1�9 <br /> rasa print or typo.(Form dasl,nact for use art elite(12•prlch)typoveritot.) <br /> UNIFORM HAZARDOUS <br /> 1.Gertorstar ID Numbf:r 2,Pnga-1 61 ;i,�'r:;•�ni�j[24:6p+:rrsrrE'It �^ 4.rAanffusl Traekiflg Hrur+lmrv <br /> WASTE MANIFEST ('Al it(1:i i')B G 9:1 � f,:,);:j-.s.: f.i;i00 0 68700�9 JJ K <br /> ailing addfoss) <br /> 5.generator s Name and MaAfny Addtoss C,onerator s Stu G.ddst ss lit tt![fefenl Uan m <br /> iivll�k'I�{Rl <br /> I'll WASH I,Il R?CI'AIR JAZ tfill . <br /> '-rA41 W.YOSEMITE AVL JA Z Ol;�f.�t�l%Il <br /> Genwal6rs Puerto: U.S.EPA tD Nurl <br /> 6.Transporter 1 Company Nems I /i I::EJ _?t' i t):i ti <br /> �N- 011OIl <br /> .� U.$-f.PA In Nur 1;r <br /> 7.Transt�pporler2 Company Name t;j,,f-;t i(;-'i` 'r -Ei 2 J <br /> '+JtJI?LC7!N!{7L-' l�lwi:-C?Vc:1;'t:�il'�hTk:l'rE If�li;, <br /> u.s.El'n ID Number <br /> 8.Desighalad FaclillyName end Silo mdress <br /> 1}Uf-IN YES I.LI; <br /> ?130 E '13'11.151 !'�. 1 c;1+:?;;f:.; •.l 6!7:2 4 <br /> UlvIrl <br /> Foodit}' Phone: 10) 7crg <br /> PA ie-CcntnsaErs 11,Il Q.Unit 11 waste Codas <br /> i#ib,U.S.DOT Description(Inofud! Pr r 8hi ing Name,tiaaud Gass;IG NI"b6r, Quantity WlrVol <br /> HM land Packing Group(It any)) r+a. Type <br /> Nf)WIZ'ORA HALAll WA61'll S)CII_i0(CAL'i `i"'31.11). <br /> 00 D fV1 f <br /> LU <br /> I <br /> i <br /> i <br /> i <br /> 14.SpeClal Han Ing Inslnrcllons endRtldRlnrsallnSomratlon } y <br /> 1lVlFlI�IfiYCC)l�'Il3Gi :i'flL•li+TFZEG :f• c713$ <1-�s;:i(+I tNC}1:;; lf.fslii114sL.,,:..r, 4 1 U'll.r. .r :-! <br /> Qkt;Y 301.R.). E'Al'ER <br /> 15. GENERATDR`SIOFFEROR'SCERTIFICATION: I11EV ydaclateIn!Ill hocirnibnt9:—of thisionslgrmi°s!�or�tf:yarrdn�Curxleiyd0s?retlabr+u bygrgpro!rersilipPnSrn+n.e,ur�lorec!asslkad,packary <br /> risalked and iabeledfplacarded.end aro In all rospocls in proper condition[Or(farisflnrt nrcafd[1g l4 t1PPI•CENe tn:e n�1 r�inl and national gueeinri la4 rogulakieas if nxpo:t Stli;l"IOnl and I am'he primalp <br /> xpaler,I Gandy 1hal.lhe contents al lhte consignment conform lathe tar stmt be nttacisud t()Akknowladgrstw�,i of Consoril. <br /> kerrify that the waste Minimization stalomen identified In 40 CFR 262. !(a) I am a largo quell gonafator)of(b)(Ir l nm n shalt QUari)ity generat4�is true. Month Day Ycar <br /> Generaloes!C!foror'a pfinlo yped Name 1 Signature / <br /> ;.,1 16.In naFS rlsrnons ❑ImpndlnU4. ❑Flfmrtfrosn'u.s �- P+rrtoisMryfexit: <br /> 1-- Uri1G1e iriyU.S.: <br /> A Transporter signature(for exports only): -- <br /> od 17,TiansporterAcknowledgntont01Rocalptolr9•denals Month Day Year <br /> Trans' r S Pf hied' 6d Name <br /> r 0A, <br /> r r Ce t3s! D <br /> z Tr t 2 PI ted pe ams <br /> 16.tilsorepaney yy �--r--�•-�• <br /> 18a.Dlscropancy btdl6atlan 5p04e ❑ quanEfly �J Type ❑Ruskiuri ❑1181101 ltejacUan ❑Buil xalecUon <br /> ftari!lust ktefrllrutrar t+iuin>;er, - <br /> U.S.EPA ID Nomber <br /> 18b.Allernato Facility,(of Gonefatan <br /> J <br /> LL <br /> Facility's Phone: htonlh Day—year <br /> w —IC:Signature of Alternate Fal or eneratar) <br /> LD19.Hazardous Waste deport Management Method Codes(i.e.,codes for hazordotss lvasle treatrrrsm,disposal,and feGyc&:�1g s;s'.enss) <br /> 3, 1- <br /> 20. <br /> It I 2 <br /> Design d Fal Cwnur or Cperalor..Cedifrcatlon of recofpt cr haeafdoue nrnleriats ril by the manifest i copt as r' e,in Itam 18u A1onVr Day Year <br /> nntedfTy d Name 5ignnlu f <br /> EPI-Form 870b.22(Rev.3.05) Previous editions are obsolete, 13U,0310-N1.1 'N:r-1 1', IAN iT1 <br />