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Not <br /> 1 I .gl1NERATOFi!S10FF.EROR S CERTIFiCATION:. I'tterehjrdeclere that the contepts of.thls consignmantarr (ullyQnd ascuratel dasc 1 a r� <br /> marked and tebeledlplaoerded;and areitl a9 respects iri'propar toted@ioq 'for trap9Port accotding to applkbNe Inlernaliotiai and nalloriabadvamine i proper shipping name, eld Bre dassffled, packaged; <br /> Exporter;"I cetUfy Ihalaha .conlerita of ihfs'cpns(gnmeptconform.to iha ierms of the �8ached EPAgcknowl@dgmentof Consent: ' ' g°` reguletlona, if export shipmsnl end I am the Primary <br /> % eerhaylI I Ithe Waste rriYnimlzoiiQn'staiem nl itleOW In 4Q,CFR. 8227 a tt l am a lar a utin8 enettif t 'or <br /> :1 :: .. .•; . . <br /> ?: Ga nem3tor'810HaforB r(ntedlfy edJJame' ; : + ? , : ( JJ g q h' g 4 )t (b) Cfiemasmallquenlftygegeremr) latae, . <br /> all P P4 <br /> } , , Sigpafure � ` <br /> t i a. , c. , Stfi tp' 1 . J + _,., • . Mon /0y Year , <br /> Now <br /> Pop • ' 1111. .; <br /> pof <br /> . 00k �.:. . . f. t. i c ` ,. r 1IV <br /> man I. @; nterttalionaiShl merits ' ,S4` <br /> y., ' <br /> � lmpold totui 3 0 oft from U,S, / <br /> lransporter'sTg'nalyre tfoi.e ' orts only : " P, Pod of §ntryldxi•C - 1 <br /> 17:Tietis er' Dale leaving U;S;; i <br /> po .-4ckifot4)edgtiientofReceiptoaM}itariNs` ; ;• , . j ;`; <br /> Transporter' RrinfedLT e N f "' ` F.YA am6 .. » .'7'_ r' 'Nall = f ;S19palufe s . rk " fillr v .low liiiiii ill <br /> a ��. 1 < ' / . . .f.., 111 r xy •:. r '. ,Ar <br /> �. /.. , r,. . „ n=. : ✓ •'' r + ' (von h a r eai <br /> z Tralisp0,rtar 2 pop <br /> Prince ed Na . f ,,r, } <br /> Q EYP me f+' at .. C:,s••all r'` , <br /> got t IV Ighalure <br /> P pw IN . pop1 ' : Month D"ay" Year'= <br /> i8• Dtscrepa{icyI TV <br /> plaI <br /> W; <br /> '18a.'D.IsGe `r'' <br /> Pattcylridlo9tlouSpaceIV W. IR <br /> I El PW 4 Quantity � TyPg; ° `. IN <br /> ow .. ORestdue ' ..0 No , <br /> Partial Rejection ' FuY Rejection <br /> , .. J <br /> I Alternate Fac(l[ly (or Generator) MaN §E 8ference Numbor: <br /> to. 1 11 all INI <br /> U.S: EPA.tD`Number <br /> LL PAcNiIysPFane: <br /> 18c, Sigtfalure of . female Facility (ot Genaralor) <br /> Month Day Year , <br /> 0 WN <br /> .19. Nazar <br /> dPt{s Waste Report ManagementMethod.Codes {is., codes forwaste Ireatin@nt, disposal, b111r11 <br /> III Wsystems) • - pr WIN, I to <br /> IN <br /> 20. D'eslgga���;lao�lltjiOwnerorOpftrst r,.Cettflicaliori Areceiptofhbzardous;matgridls`covaredby, themanlfesl,gXOpt'asnotedipItOm.18a <br /> Print, Yorhe me 1 . 1� � <br /> 1 4 t , ignetu(e . <br /> E P . law T. I It I ' V.�d { � .. 1t, G1 Z•.1 � '� " 1 ,. onl ay, Rear <br /> PA . . orm;87� 22 (RAv, 3 45} .Previous editio : ' a •• <br /> .i IN � , J <br /> f , ; .: ns are obsolete, <br /> { RTE <br /> r " F TRANSpb <br /> It 04 N. . . . R S :COPY <br />