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006686556SKS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number ., },, _rr„ 2.Page of 3. Rgspop�se PI'op° 4.Manifest Tracking Number <br /> .hi:,t,,�, :h: 1006686556 SKS <br /> WASTE MANIFEST <br /> 5.GgRrleratorspame and Marling Address Generators Site Address(H different than mailing address) <br /> +-rr <br /> T R A rn., - <br /> Generators Phone: c 0^ 8371- 13 10 4 <br /> S)?-TFMS INC U.S.EPA 0 Number T���syr lr,, r <br /> 7.Transporter 2 nx Name U.S.EPA ID Number <br /> CL F'� ) r-NV PONMErIT�1)- :1r. ITqI . _,- <br /> .. <br /> 8.Designated Facility Name and Site Address C:L•F qp HARBOR" 1)RF 0!`-JjT�,, ,_t,t:, U.S.EPA 10 Number <br /> 1I�s?@ NORTHAPTUS ,Misr <br /> ARAGONITTF "1' 4�!i; <br /> L _ <br /> ? <br /> Ii- 't17 1'. 17 <br /> Facility's Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity WtNol. <br /> . i. L)A!i' 5 G!ArTE • ;.Ah1 gfjBt.E cC?t_TDSS nM r' 01.21 FQO� 11001 <br /> O t1Fti;^r,},• fl,t?. y r{ir+rTt�kdEi 'tl;,t; J( ? <br /> e F -r --+ <br /> W <br /> Z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TCI; 71-7 <br /> 241-11 EPiEf?GENC`.'#1300-.-4r S-1760-l"ifISF 2", T Ci:T-it «_t et.P.r,._, ;,i� Cataf.t'rr-'�_ - <br /> 13-n-3TTI}Ial trans 'r,,ter to add OY 5,1FJat i�t_ttn 3i C;.t;�( ld1 tY. lit i Y't er'� cp enera GY" 4 iTr; <br /> 15. GENERATOR S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are kitty and accurately described atone by the proper shipping name,and are classified,packaged. <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governments regulations.If export <br /> Exporter. <br /> I certify that the contents of this consignment conform to the terms of the auached EPA Acknowledgment of Consent shipment and I am the Primary <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f 1 am a large quantity generates)a I am a small quantity generator)is true. <br /> General er s Printedgypetl Name S' tu Month Day Year OL <br /> Q 10 Ila I le- <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entrylexit:. <br /> Z Transporter signature(for exports only) Date leaving U.S.: <br /> Of W 17.Transporter Acknowledgment of Receipt of Materials <br /> � Transporter 1 Printed/typed Nam�e /d y Signature Month D <br /> d ,.,�i7 4AJ� +�C�/ � Year <br /> O <br /> LwWrter 2 Pnnted/T arae Signatu <br /> + Month Day Year <br /> u o z.3 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) <br /> U.S.EPA 10 Number <br /> J <br /> U <br /> U<- Facilitys Phone <br /> W 18c.Signature of Alternate Facility(or Generator) Month a Day Year <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1' 2. 3. 4. <br /> O <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as rated in Item 18a <br /> Printed/Typed NameS g a Month Day Year <br /> HCAIF" A4 <br /> c � Y <br /> EPI F4r"-pt-2(RQr(. 17�P{euious editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />