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rn <br /> C0 Cl) <br /> LO N <br /> C O <br /> O <br /> ry- 090011MO <br /> n o O <br /> 0 <br /> O <br /> 0 ad lot unc'm olnn I:nlrlo 1 ynwrlkl. Nyyn.rr,'a,MR li•r 2(1WI139 <br /> m 1 1'.nnern4rr I.Nrtt"l+'r yY 1�;I I_kr'NI�YN.Y Nov1�n,.n Vlvnu. Y{rp Numbr �— <br /> L.L <br /> pMW�nn ar�bfY Rio PrinrmstH rllnnr.n,l ll�nri mn nNb�t.� <br /> ri <br /> y- <br /> .. <br /> IB <br /> U s F.PN li,`b,n.!<. -ant Yat'M Re DtHnYY <br /> W <br /> nnurrman <br /> tm Sir,Add» IJ.i EF'N 11)1.1,71 r Mn <br /> 11 <br /> and P.IiYHy Ywij Pmprn Snryl'rng Nnnw.H.vnld CI.l4h ID Num,nr /e.CnnelMrs I I TUWI 12.Unci <br /> qp tis Dt I oescnVln,n lltW v <br /> l ll.elYll Na i Dir a IA x <br /> NM 1 I <br /> 4J <br /> C <br /> 0 la <br /> .Mditional lnfortnauon <br /> Spacial Handling Mio <br /> Insmns and <br /> in sh <br /> pmg Is a.clrissl <br /> 0 .o ,,1R and a,eleNp eaOtded.aotl a—M" .110 .11. bPrope acond bonfor Ua splM according to applicableumte ahonal and atonal govemmental regulations)it export sh,pmam and I am Ne Pan a ry <br /> Expotrer.I cenAy Inst Pe a'lof, of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent �Y t <br /> _ I c"ty that the waste mmmn.bon staemant idenfifled m d0 CFR 262.27(a)(if I am a large quantity Signature or(,)til am a small quantity generator]is true. Day Year <br /> GanemlotvORerofs PrintedRyW.Name <br /> Imematicnal ShipmentsImport to U.S. ❑Export from U.S. Port of anlrylezil: <br /> i— Date leaving U.S.: <br /> O = Ttanspnner signature(tor exports only): <br /> () ¢ 17 TranspoarAL6awledgment of Receipt of Maenals Sigature Month Day Year <br /> W n <br /> Transponet f Pnned;I ypad Name <br /> 0 O Month Day Year <br /> n Signature <br /> CTtansWiter2 Pnnlad?yped Name <br /> C � <br /> 76 Dturepancy <br /> (p El Partial i ❑Full Rejection <br /> 0) 16a Discrepancy Indication Space Quantity JType ❑Residue <br /> •C U) Manifest Reference Number:i <br /> U.S.EPA ID Number <br /> D lab.Allemate Facility(or Generator) <br /> C <br /> Y FaulilyrsPhone. Month Day Year <br /> 18c.Signature of AAemate Facility(or Generaft <br /> O <br /> z <br /> 0 y 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> •I <br /> LO O 7 2 3 <br /> O r <br /> N <br /> _O 20.Desgated Facility Owner or Operator Cadifica(ion of receipt of hazardous materials covered by the manifest except as noted in Item 16a Monts Day Year <br /> O O PhnledRyped Name Signature <br /> Q <br /> EPA Form 0700-22(Rev.3-05)Previous editions are obsolel a <br /> GENERATOR'S INITIAL COPY <br /> 0 E <br /> O = <br /> � � C <br /> U _ <br /> a) O in <br /> U C7) <br /> LU <br /> X00 0 <br /> � C Y) LZ <br /> N O U <br /> N = <br /> � � rn <br />