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o_ rT <br /> Please prino_t ar typ (Harm designed for u�sa on elite)12-pitch)typewriter_) :/t'.��' i y Fnrm Approved_OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Geneminr In Numhar 36 2. age t d1 3.Emorgoncy Resnonte Fnone a Man Ncsl rracxeng Rumnsr SKS <br /> WASTE MANIFEST <br /> 5,Corrcnainr s Name and near rng Atltlress Generators SNI Amir.-.a lit iur-r�rN m...r mailing address} <br /> ,.7'1� <br /> Generatlrs P -' <br /> G.Tramp I-Mrnl Company Name yts_EPA 10 Number a1 <br /> Transperier$company Nama V.S. ID Numb,, <br /> `r'1 <br /> _Dasignatatl Faciiiw Name amf Site Address - 11.5.EPA ID Number <br /> Faritil'n Ph— <br /> qa S_DOT Description(including Yrupor Snipping game,t-t—M Class,ID Number. o.Contalnem 11.Tdlal 12 unit 1l.Waale Codes <br /> HM abed Packing Group(1f any)) No- Type Duendty WLfV01. <br /> 4 <br /> 2. <br /> 3 <br /> 4. <br /> tA.Spacial HaP ht Inetrvctlon¢antl Additlanol W--- TOE)i GM - - - - - <br /> ]'IT—Rtsr jrjf, 44 -.gs:fs: <!- ©1 tBN 1 TFTi <br /> is GENERATDR'S/OFFEROR'S CERTIFiGP fDN_ hereby der]are Nal the contents of this consignment utry and accurately described above Ly the pronar snipping name,arra ere classlfiatl,packaged. <br /> ked and NbnNtl/Pl:mard,d.and era in all respects in proper canditidn T Ir,nsPod arxxatling Iu applicable inlernaliOnal and natwnal govemmenWl mq.l.t—If expert shipment aha I am the Primary <br /> Exporter,t—rtify Nat Ne contents pl[tris wnsignm,nt wntorm I-the leans of the atlachetl EPA Acknowledgment of Consent- <br /> I wrtdy ural the wwta mtnimizavan ssa[emem kdentifietl in 40 CFR 262 py(nl lif 1 am a to age quantiry generator)or(b)(!f t am a smolt nn.AniiN pnueratur)is true'. <br /> C-.uneralorsfOflerols 1'nntearc petl Name tore Month —Si Ycar <br /> l6.m�ma annl 5nipm�n.. o Imp° t° 5 <br /> Export from <br /> Date of antrylU S <br /> 2 Transporter signature ffar expnrls nnly). teaving -E.- <br /> N_Transporter Acknowledgment of RI-111 of Materials <br /> Tr—npnrter 1 Pri t—Typad_Nama Signdture Monty Day ear <br /> O <br /> Transpnner r Pentad/YPed Name Signature untn Day Year <br /> 16.Discrepancy- — t� <br /> 180.D—IPanr-y Indidalipn SI—r O o'—fity I�Type Residue LJ Partial Rejection I....1 Fukl R.J.— <br /> W— <br /> e)eciienW le Report Management Method Cede.(iur.,cudus fnr hazartlaus wast,treatment,dlspose and—Y"ing syrmms) <br /> Q t <br /> 20_Designatetl Facility Dwner or 0-1-It" Certtlicatlpn of receipt of haiarduus meterlots—1-1 by the--f—except as eaten in 1—tae <br /> PrintedlTyped Name 51{tnalum Month Day Year <br /> GPA F.1-8700-22(R.Y-3-05) vrevtous eddinna are nnsolete. r3ESlnP4ATEl3 FACILITY TO GENHRATC)" <br />