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f - ] <br /> pleaie pant at type, <br /> Farm ApproYed;:Ol�lt3 No:20Ut139 <br /> UNIFORM HAZARDOUS 1 GaaerdtorlD Nurdhet2,.No 1 of I EPoOrgenay:Respcnse Phonff 4.ManffestTra� idrrWe <br /> IFEST <br /> C2 1 l69�'A7 Q7� <br /> WASTE MAN '3t. 16 JJK <br /> 5.Generator's Name and Mailing AcltesPETdA1Y <br /> G$neta[ar'3 Sile ltiddrese(rf ditferant.ihari metling addra55) � <br /> jk Cal, <br /> Generator's Pha <br /> 6;,Tta11300rterl CompaityName <br /> 11S EPAlGNumt>et l <br /> 7.TwppgMt2 CampaNy' ame <br /> U� <br /> REPADN:: <br /> B.Desrgn ited FaaHty Name and Site Address. <br /> U:g EPAILNurehef <br /> # <br /> OS EWRt WNTAL�*RtJIC INrw. <br /> Fadlity's"Phorie �r +19b.Vat. D <br /> 7 i <br /> HM:1M and Pe xu 9 roup Y)): Pmpei9htppsng Name Hazard Pang,IR'�{umf3er, Ia.€anka(aets <br /> .., u�H WENa1 1&:VltiffGodes,. <br /> No. Type <br /> � <br /> 2: <br /> 1 .r <br /> C <br /> , <br /> 3 ... , <br /> ' I <br /> q . <br /> i <br /> "l'q - <br /> 14,:Speaaltiandlmg lnslruCUD rrs and Add�lionaj infaiatlan <br /> E t . GSf!ItGT13 . t$A141G1 "�# Ai, f <br /> t~I tiUtt RS tf 31Ji FOS "l#jp°gip U'i RWPR"o PPE <br /> I: <br /> 15. GENtiF#1tTT01 S1 FPERtlt;'S CEITIFICATIdN,.i har by 40,giare thatths c'l a is ofihls copsignmaniara fnfyand aGWIt.d t described above ;thf;proper.f 9;'"ine tiid arQ ctapsrHed,padragc�A. . <br /> ni" ada?id tatrai laaanfe and" fn epi res <br /> rtes i „P,,, <br /> PecternpropeioondillonyfortransporEarwrdrngfQapplirn3f:feinfentafioaalndnatwnaigovetrtmenial,reptrladone�ahlpmeaanA'IamtheRrlrhary` <br /> titpo" ; cefifyi atlheaonleitta'dfihiaedrisigriirterifia€rtlumtothelamsafihe''atlecbedEPARaNiowledghten ofCanseat S <br /> i oaf1w,#iat the waste Minimlxalion statement tdenGFred in 40 CRE 282,27(x}(if.I am a Igte quantlty generet6).4(h)(Ht am a,sW11 qua ngtygenerstorMs hi." " <br /> GeneraloYslDfieror s Prtnledfl"yped Name Signlwre Mtrgih Day "Year <br /> IA <br /> 'S pmenls rt to t15, <br /> Po �ExportfromtlS pq�idT. <br /> Inj 1aiCH. <br /> � Trart3�rtar"si nature{Farexparts onfy}; �. <br /> E 3 : <br /> W17_TransP�tarAcknawled4n)entaf';t s41 tofM�tedal cd <br /> rz Transporter 1 PdntedrTyped Name,,; ,e, A SIgr blur Mon gar <br /> T�rtiar?PnhtedlFyped area <br /> e <br /> „ + Signa ar <br /> g# <br /> �tonlh Day <br /> Space 5... El Quo O T e 77 f; <br /> �I rr--ff .3 <br /> 18a.,prscieipancy lnd cetian . YP Q Residue LJ Partlni Rejectlon FuH Relactfon <br /> • ..: ..ManfesttteferenceNumber; � <br /> it}b.AlieinaleFedlly{prGgntalor� <br /> t .» Ua"EPAIDNunii�r, <br /> :V t <br /> rL <br /> Faciiityd Phone; <br /> 18c:5 aala WAttemata <br /> t�x Faciilly(or Generator)'" <br /> :Yeor-: <br /> 19:Hazardaus Waste Report Mariag8.meht:Method Cads(i e,modes fa hazardpus waste trealriient;'tlisposel,and recycling sy4lems) <br /> t' 4 <br /> 1 <br /> 20.Designated Fecr#dyihMer or Operator 6ertEfiaa69it:afYeceiplof liazardousmateriels.catiered by lhe.fianflept except as nded in Item 18a <br /> PdntedA'yped Name 5i nature <br /> 9 Marifh "DaY Year' <br /> - I <br /> ^( ous editions are:obsolete . <br /> ERaFarm 870.0-22(Rev, �7) previ,�. _. DESIGNATE FACILITY COPY <br />