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11111111111111111111111111101111111 <br /> 7,1-5 7-a v-5 In 0 0 6 5 1 3 7 4 0 5 KS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> S 1 1.Generator ID Number r rise NIL --'F-A—tantest Treating Number <br /> '1 74 , : <br /> UNIFORM HAZARDOUS 2.7Verm(A RT�, <br /> WASTE MANIFEST 1006513740 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> f <br /> Y <br /> Generators Phone: <br /> 6.Tran U.S.EPA ID Number <br /> ,rrte m <br /> 0 Cc pany�q me <br /> �—1 7V5TFMF, T�I— T <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> ENV !,.l-„r..,,:0-.1 it <br /> 8,Designated Facility Name and Site Address HARIT1.0r,17 i;�K! T-'•c U.S.EPA ID Number <br /> "IR!” <br /> Tr�I <br /> i T <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contai is 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No Type QuantityWt.1val, <br /> Ir vl PC PP, Hp.,I-P,,-:Pmt! :, WASTF- MIL T Pc; <br /> 0 7, r M 7 T 7� rjF7-P;-1! 7-11M W-ROCArlep"ON-0 <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Addifional Information <br /> TF'"' CPEP,:afiCIGV ,T) q-7 <br /> 'FN [7 <br /> P I -af--.P,--I 7FO, 1C!j 7,K T <br /> 1w C, Tn <br /> 1 GEN' theis consignment are fully and accurately d—eftW above by the proper shipping name,and are classified,packaged, <br /> 5. ERATOR SJOFFEROR'S CERTIFICATION!I hereby declare that of this �'�� � re fu <br /> markednd labeed1placarded,and are in all respects in proper condition for transport according to applicable internationaland national v mentax regulations.If export shipment and I am the Primary <br /> Exporter,f certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmart[of Consent <br /> I certify that the waste minimization statement identified in4QCFR 262.27(a)(ifl am large quantity gerCfor or I ant g^at(r is true. <br /> Generalor.,e',1nintUAITY Nn �0 , S n kfgnth t Year <br /> ty, <br /> 16.International Shipments <br /> I--]Import to U.S. ❑Export from U.S. Port of enhylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> ci� <br /> L 17.Transporter Acknowledgment of Receipt of Materials <br /> L1 <br /> Transporter 1 PfintecVTyped Naignature Month Da Year <br /> 0 III (T <br /> 9L I Zq1 ' <br /> Transporter 2 Pnntedrry:f/me Signature Month Day Year <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b Alternate Fadlity(or Generator) U.S.EPA ID Number <br /> :3 <br /> L) <br /> Facility's Phone: <br /> 18c.Signature ofAltemate Facility(or Generator) Mont Day Year <br /> Fn 19 Hazardous Waste Report Manage en ethod Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. W <br /> 2. <br /> '4 14. <br /> 120.Designated Facil Owner or Operator.C <br /> piseip4ofhazar stiffest except noled/- <br /> itirinteal, Na �rtlllcafior_21 does m A�s covered by the in;�� <br /> 700-� 1 <br /> 22(Rev 3-05� <br /> Previous ,tions <br /> are <br /> EPA,Form!8;'— saste ITY�TINATICTN STATE(IF REQUIRED) <br />