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0D64616685K8 <br /> Please print or type. Form designed for use on e!rte(121Atch)typewrller.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number _s � � 2.Pa e'of 3.Err @pcy E3esPpn-Phone 4 V 06`T g N m f 1668 <br /> SKS <br /> WASTE MANIFEST , <br /> S.Garonloes Name arc Malting Address Garwaki0s ftAddkess(N dKferem than marl ng address) <br /> G&1ert�lore Pflane' t: <br /> 6. ran�ppt4�r�1. rrgllne U.S.EPA ID Nun•ber •� <br /> 4S�rri4l;i't <br /> 1:Trarwpurter 2 Company Name U.S.EPA 0 Number <br /> L7 �S~ [',]t";;s;r'�,'fi?;�- x74!'= 7��= --_ •:"r,e <br /> -,t <br /> 8.OesignatedFRcilyNameand SlteAddresb rI i s.; 1;t<c•c.� "rt4Tn`'."aisf `'.i r.; rill U,S,EPAIDNurnber <br /> NFE <br /> i,�":. <br /> I g, aid W U.S.DOT Desaipror(nclud rg Proper Shipprg Name,hr�ad Class,ID Aksrbw, 10.Colttq'--"Tyoe <br /> 11,TM 12.Unit 13.Waste Codes <br /> It Pw*! de No. Omnt# VRllla4. <br /> bs <br /> N A4 <br /> r 2. <br /> LU <br /> 4 <br /> 14.Special handlmq InsfiJcricns and Additional information T•.-1n y z(r. sr lrl A.t`9IF <br /> r- f ;+:['-.: /f /1� f;.-..=1, �• <br /> yt 1�€� i��; of 1,-.r•'i�' Fn1, y,, �'� T ,j CF rw,- ,l r^r.�RT�' ne ,� <br /> 15. GENERATOR'19tOFFERQR'S CERTIFICATION: .hemby+declare that the contents of Ma mnsgwnm are fully and somratey desctibed ab"by the proper shbpFg name,and are dassified,packaged, <br /> r-arkad and labaledidacarded,and are in a1 respects in proper condrtlon for transport acwrding to ape icable irrerna'lona'and national govemmental reguhtdons.If export shipmem Ana I am the Primary <br /> Exporler,i eaffy that the cantenis o`tHs conagnmeni cmform to the terms of the atfadred EPA Acxnowiedgrrer.of Consent. <br /> I csrtfy that the waste miz•m¢atior statement idenli6ed in 48 CFR 26227(a)(K I am a large quantity generabl or(,))(if;arr a small quantitf generator;is true. <br /> GeneraWs bores PrntedfTyped Name Sgrmture lkn.th Day Yaar <br /> 1 16.Intemahon9l hipmenta x h from U.S. NA of crit fexi`_ <br /> P ❑iww to U.S. ❑: pa ry __- <br /> Traisporter signature(`or expo is oNy): Date laavtng U.S.: <br /> 17,TrenspWer Aclrrrowledgnwt of Receipt of Malerals <br /> Trar)po.er 1 Pr' Name SignatureIL <br /> z2Likto Day Year <br /> O 7 r ft <br /> a TraHln z_j r Day Y <br /> .7MY dJ/ <br /> 18.OisCrapa•'xy f� <br /> 18a.Discrlemncy Indication Space ❑ 0uarltlty ❑TyN C Residua ❑Partial Rejacfion L I l=ull Rasec lion <br /> MaVest Relerenca Number <br /> iah.MErow FaAliy;or Generator) U S.EPA,ID Number <br /> V <br /> tai =aal�t}'s Phone, <br /> W 18c.Signature ofAkamale Facility(or Generalnr) Mohth Day Year <br /> Q <br /> x <br /> 14.hw2rdots Waste Rapart Management Method Codes(Le.,codes for nozs(dois waste treatment,disposal,and recycling soems)40 <br /> G 1. - 3. 4 <br /> 7 <br /> 20.Desrgnatad abiy Dvo or Operator Cadificaton ofreca4afhazardws^aleiiuls covered by the maMast eKoept as tried n 110m Ift <br /> PrrdetlTypai ame ��l <br /> deY Y <br /> EPA Farm 8700-22(Rev,3 D5) Previous editions ohs e1E. N TEDFACILTO DESTINATION STATE(IF REf3UIRED) <br />