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lege pr(f9tbr type,(Farm designed for uselretite(12•pltch)tyirewritar.l Farm Approved.OMB No<2050-00; <br /> UNIFORM HAZARDOUS '1.Generator lR Number g_t of. 3 Fntefgancy,Rospoase,Phona 4,tlanNahct Traoking Umltar _ <br /> WASTE MANIFESTL5 7 57 JJK <br /> 5.Genarator'n Name and MaRng Address Geherai�r s 51fdRdd ess(1f different than mora ng address) <br /> Generator's Phone: <br /> 6.Transpadar tC¢mdar�yhNamp U.&FPA ID Number, <br /> 7,Transporter 2 Co€rpany Name U.S.EPA ID Number <br /> 9,Designated Facffi Name and Sita Address <br /> tY U.S,EPA ID Number <br /> 3 <br /> F9 s Phara:. <br /> j 9a, 9b:U.S•DOT Desaiption('indtrdngProp or Shipping Name,Hazard Class,10Nm_sber,:.. '40.Conkatnam. ''.i1,Total 12 Unit ;g WasteCodesNM and Paeking Group Van));...._. . .. Nm T tluantlty 4YfNoi. <br /> r _ <br /> � '' ICS .�• �, n6ow <br /> 3. <br /> l <br /> 4. <br /> I <br /> 14 5pega(HandingbnsWcUonsandAdditlonallntormation <br /> 15. GENERATOR'StDFFEROR'S CERTIFICATION:I hereby declare that the contents of Ift consignmant are fully and aecuratety described above by the proper shipp&hg name,and are dassiried,padmgod, <br /> marked and labeledlplacartled,and are in es respects In proper condition for transport accodtng to app{Ita61e khtsmationaland national governmental ragulations,.lf export shipment and I air the Primary <br /> Exporter,I certify that the contents of M consignment conform to the terms of the attached EPA sent <br /> I certify that the waste mirdmtzation statement ldentfied to 40 CFR 262.27(x)tiff am a large quantify gone )or (ICI am a sir a generator)is true, <br /> Gane`�taPsloff morsIw 'd me s e I D Y°r <br /> T� <br /> i7 J7 <br /> 16: drnallonai ShlPmdnfs <br /> ❑import to U.S. ®Export U s. Pad of entrylexh <br /> Transporter sfgnslure(for exports only). Date leaving U.S, <br /> tY 17.TraraporterAdvoMedgmerdofReceipt ofMaterlats <br /> T Tint ypadNamey %nahae, Mrn <br /> o Da Y <br /> a Transpodat nntedlTyped a Sgna Month Da You <br /> 3 l <br /> 10.Discrepancy <br /> i8a.Discrepancy Indication Space ❑Duantdy ❑Type ❑Residue ❑Portia`R-,e-}rt Ful Re)ettion <br /> Mantfest Reference Number: F <br /> 18b.ARemote Fodtity(or Generator) U.S-EPA ID Number <br /> U <br /> u FaciHtys Phone; <br /> 1 Signature of Alternate Faa7ity,(or Generator) MatCr Day Year <br /> z <br /> S2 19.Hazardous to Report Monagament Method Codes(Lo.,codes for hazardous waste treatment,disposal,and recydfog systems) <br /> .1 <br /> 20,Deslgnated Fadll{ Owner at Operator iter)' receipt of fIqurdaus materials covered by the manifast except qqded In Item 18a <br /> PrintadlTyp a <br /> EPA Form 0700-22(Rev.3.05) Nvious editions are obsolete. TRANSPORTEF11%.COPY <br />