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C— PD NUMBER -0 A W <br /> CROSS STRFETg <br /> O_ W <br /> j NOrFS. CASH i4E'CF! W <br /> l N D <br /> N c�MMoolry rn4rol, n O <br /> O <br /> N � NDN-gCFZq � �~` Nn, – D) CD <br /> 7 -OPLgrnCD <br /> CD 7 <br /> _ O CD <br /> (n Form Approved OMB Nu-2950-3039 <br /> Please print or Pe.IFOn des+gned for use on elite(12.pilCh)lypewnter) 4.Manilkat Tracking Numter . O <br /> A i Generalor ID Number r Paso 1 0l 3.Emergency Response Phw+e JJ <br /> UNIFORM RAZAROOU5 <br /> DI WASTE MANIFESTadarns9j QO <br /> 5 Ge�ralMs Name aM M&N,,4 Address Generalar's Slle Atldross IddVHeranl than mailing <br /> O <br /> O <br /> (,� Q GreTerabrs Phone U.S.EPA 19 Number L <br /> C T.,,xi r it 1 Campanl'Name L <br /> SA US EPA Ip Number <br /> rill •r,ansa+ne'?CnmPan�Name Q <br /> 1 ' � <br /> a rreygrraled F,y['I+ly Name and SNB Address U.S.EPA 10 Number fn <br /> ICD <br /> Milt CL <br /> Face"Ponrre: N5 C <br /> 9a 9b U S DOTOew+pam yncmdmg Proper Shipping Name,Hazard Class.ID Number 10 Contarncrs 11,Tula) 12.Unit Waste Cuaes ;I C <br /> HN and Padring Group fpanYll No. Type Ouantily WI.NoI. AN )3 <br /> O <br /> o !I- � 1�� <br /> v <br /> SFa <br /> W <br /> A cn <br /> CYC 1 1.7 -- <br /> u (D <br /> 1 C)- <br /> aFrF} 0 <br /> rtu; o <br /> '4sri � <br /> FTS � <br /> S'W, t <br /> 8S <br /> 1 <br /> rt SpeaaHanm�g n,Twfws and Additional Infomralioe <br /> 1 <br /> f 5 GENEAATOR'SIOFFEROR'S CERTIFfC iow I hereby declare that the contents of this Consignmenl are fully and accurately described above by the proper shipping name,and are classi packaged, <br /> marked Ara iabHedfplacardedand are in all respect rn proper o0 ition for transport according to applicable inlemationaland national governmental regulabdns.if export shipment and i am the Primary 1 <br /> EapOrhr,I cerMY that the contents of Ons consignment conform to the tens of Hte attached EPA Acknowledgment of Consent. <br /> I aer*brat i waste mierm¢aban statement identified in 40 CFR 262 27(a)(I I am a large Wilnlity generator)or(b)jiff am a small Quantity generator}is true. <br /> Ge`vrAY Olhrors PmuedTyped Name Signature Month bay Year <br /> F16.lowmiabonal Shpre ft 1 <br /> ❑import to U.S. ❑Export from U.S. Pod of sell <br /> Z Ty idporwMW exports onty7: Date leaving U.S. <br /> 1T TraryputarArxnpniepgrnytl d Recsgl d Mals g <br /> Q! TrarnPor 1 PirrvaduRypea Nern6 Signature Month Flay Year <br /> Mwa4„ <br /> Sl ypod Nam <br /> Signature <br /> Month Day Year <br /> %orpepricy <br /> ❑ ❑Type ❑Residue ❑Par,al Rejection ❑Fuli Rejection <br /> Mmrileet Reference Number, <br /> U.S.EPA ID Number y <br /> O <br /> n <br /> O <br /> Month Day Year Q <br /> MNY od Cadea(iA,C'06M Im hl7N6oua WWA trSWel l 1, <br /> 7 dlspo,at,in0 rrGytdlrp eY ! y � <br /> O <br /> Car6Aamnoffoc@Vd110iArtlatM h1'rM <br /> www M+7�IdiIILr1119a <br /> _ _ Month ay Year 1 ON <br /> am WOW& � <br /> 4 ` • GENERATOR'S INITIAL CGPY <br /> o .� <br />