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Pease pert or hype,(Form desi-gne`f'r ^n eine i 12.p;tch)type;�lrite r.i For.rn Approved.OMB Pio.-2:05x9-003; <br /> UNIFORM HAZARDOUS - Umder Z Paget 1 J 3. P fln�fastTracking Number <br /> WASTE MANIFEST 003701422 G B F <br /> 5 Ge^eral&s Name and ti:1a t'rg Aidress !Y 1 3 i �j�� Garerar ra Si: ,d rc s! 7cr-.r„.ha a irg i�dress; <br /> 9fl L4 L4 <br /> `M 6/A 'I <br /> Gereratars PhcnP a <br /> 6 7rarsperter I Cempar.y+`fame USE?A'� .,'^ter <br /> -A— - — — —� - <br /> 7 Tra:!�, .��_ cmpany Flame r-T'_ � - ;�j,' = t� - <br /> i'a'L,,, '. <br /> B.Cpsigrated Facll:v Name and Site Address r - h U 3.EPA iC Number <br /> ca <br /> Favli y's?hone: terfi--- g=21 C <br /> 9a. 9b US COT CescriltdcP(ir clr;ding Propef Snipping Mame,Hazard Class,Ip Plumber, 7.Ccrlain:e13 11.Total i2.Unit <br /> Myra and Packing Group(if any)1No, T e Cuanti*y y'tt.PlpE. 13 tralaste Codes <br /> 7 <br /> f1J <br /> 2. i <br /> L <br /> i <br /> i <br /> � I I <br /> 14.Special Handling Erstric°tons and Ad{ciccnai;nrormaurr. <br /> 15. GENERATOR`S[OFFEROR'S CERTIFICATION: I hereby declare that the certents of this consignment are fully and accurately descrihed above by the proper snippirg name,amJ are ctassiFed,packager;, <br /> marked 3rd labelediplacarded,and are in atI respects in proper ccrdit or tar transport according to.applicabla irttemaiional and rationa;govemmer,61 regulators.if a,por.snip,^?nt ar:d I am the Primary <br /> Exporter,I certify that the contents of this consignment cerfcrm to the.erms of the attached EPAAcknowlecJ inert of Consent. <br /> 1 cP6'j that the waste minimization statement idenfi ied in 47 CFR 252.27(3)(if I am a large quantrty generator)or(b)(if I am a small quantity generator;is true, <br /> Generator`s Ofreroes Printedlfyped ame Signati:re 1ronth 03 <br /> �j 16.lnterna5on Shipments <br /> 1- ❑Import to U.S. ❑Expert from ll.S, Port of entrryrexit: <br /> TrarsGorter signature(for exports only): Da'y leaving' .S. <br /> Lw 17.TransperterAcknawledgment of Raceipt of 4lateriats <br /> � Tra sporter 1 P irtedrTyped Fume s Signat a Nl,rth jDay IYeaTrar2r 2 r'r nted Typed Name Sgrature MornFav <br /> 13.Discrepancy <br /> I&a Discreparcy lydica.Fon Space. t t ~. <br /> El G Uan':ity .Tye Rasidue ❑Partial Ra; Csr ;,EI R ecticn <br /> 1.13^if�it�zrar_°CE PiL.r'G?!': <br /> 1h Ai afrate I'Millt'i,Cr Gerarat:rj J,'.1,El-A IU NumC� <br /> J_ <br /> U <br /> ua- =acillrf's PP,cne: <br /> W }:xr,J'��.^.air?1�?.�-v�:d�e .,.i,�� Cr U?nar310r1 �3. Y?ar <br /> Q <br /> ? ^vG53 - r-. <br /> �r1 � 3 �: <br />