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Please pant or type.(Farm designed Tor use on elite(12-pitch)typewriter) 4 Form Approved.OMB No.2050-0039 <br /> UNIFORM A2AR1 Generator In Number I Ps—1 n1 1.Frnerg —Response Phnna 4,Manifest Tracking Nombar SKS <br /> WASTE MANIFE,%S-r Y <br /> 5.c�xnxrators rvamo and Mailing Addrass Generator's Site Add—(if diffe+em than mading address) <br /> S?hono' <br /> ti.Transwrter 1 Gempany Name u.5.EPA 10 1umuer <br /> _iraasponer 2 Company Name LLS F.f'A ID Number <br /> S.Designated Facility Name and Sila Address U.S.EPA ID Number <br /> s pnona'_ <br /> t9.. gb.U.S.DOT Descdplion(indutling Proper Shipping Name,Hazard Cissa,fD Number, 19.Conlelr»rs 1i.TGeI 17. Unii 13 ybnsfe r- <br /> PIM and Pamdng Group(H any)) No. Tvpe amity W,N 1. <br /> 1. <br /> i,l i}il! F'L f:r' Wfz:='€: t, .,;,a.e.r l�. <br /> o FTFIYLEME OI„Y[OL SOLUTfIDN (Lfr,SS iNAn <br /> 3, <br /> +n-spaaat r tantllng tncwcrons and Addnienat inia•..�a.�on <br /> 15. t3ENERATOR•S/OFFERCR'3 CERTIFLCArf <br /> .r]N:I hereby declare 11iat th.admen. dil <br /> of s bbnBiQ nment�m ropy arta accurately bove by described at,proper shippir Hama,an0 are classifietl,vackagatl. <br /> arked and laheladlplar:ardad,and era in ail—p—m--—d—for tmnspnn:mrnrding In appli.bta inlernatlonal and nalioual gpvarnnranlal regulations.If export.htmuxu1 arm I arrr G+x Yumary <br /> Exporter,I certify that the mntents of thig consignment mnfonn m the berms of Me attached EPAArJmowl.dgm.m of Consam_ <br /> certify that the waste minimization stalamam idenpfivd in 40 Gi=R 262-271a)(a I am a Iarga avanMy generator)yr(b)tit!em a sma!!..anti[y gbrreralvr)is <br /> gnehsre trug- <br /> GenaratersrOfrxraJs PAnfed/typ¢a tuama i / �' Manlh gay Yoar <br /> N ` <br /> _ Is Inremnnon�,I shinrnen- 0 tmpon to us. O export tram u.s_ P o+ ' 'ta>uc <br /> Transpartar srtinature(for rxp.plc only) Dale vlrrg U 5.: <br /> W 17.—-ft-Acknowledgment m Rec..pt of Materials <br /> 1'rauspunxr i Prir�lxdl lypx'1 Nart Sigrtalure Muulh Day Year <br /> fransporlerl E•rintaa'[ypvd name SiBnelum nnu. y vn..r <br /> ♦ +B.6iscrepancy <br /> IIII{ 1ga Discropancy Indlcabon Sp— Q gvandty ©Typ¢ Q R¢sinueIecrron <br /> P.—Re)ecGon fun Re' <br /> Manifest Reference Number: <br /> 19b.Alternate Facfl[ty(or OeneraTnrl u.5.EPA lO Nu.nher <br /> LL Fa IwE f i-- <br /> I-Signature of P.emafe Facility o ceneratoN Morrth pay Year <br /> �= 19.Hazardous W. Repan Man.g.m.rn Method Cade.(I.e..—J..far hazardous waste treatmem.disposal and recycling sys[e mel <br /> JG 1 P 1 h3. - 3. S. <br /> 20.De Ig 1 d F-11*�Her yr Operator GertlWcagon vi receipt of b—,d—mot—i.6—tiered lw the manifest-1 1 <br /> _ <br /> In—dlTyp diq—'. l-. Mwtih 0" <br /> iY <br /> EPA F,-8700-22(ftev.3-05) Previous editions are obsolete- - DESIGidATEC FACILIT O GE RATOR <br />