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> � g � . <br /> � a <br /> tr <br /> . .. . : <br /> & <br /> M . .. .y.Jti <br /> Please pi{tjt ort s . +lt�Cr , #or use on elite 1� iitcfi 'i �wntet: ' Fortn. ;;OMB No. 2050 0039 <br /> 1 Gonerata ID Number 2 Page i o mergencyResponse one ant eat aq num r <br /> UNIFOtiMH RDQUB L # 4 , ' I Fr <br /> WASM IFESfi...... 13.8 � . JJK <br /> B: tt d5w - :r n Gatreta s drBerert than mailing address] <br /> ¢yypyy,ppkky� } <br /> t, FOA <br /> Qanarntet'at?hvtte,. <br /> fi;Transpo ... .: <br /> 5 <br /> ' . . <br /> ... ._ <br /> . ;.; <br /> Z. i ransperter 2 Company <br /> . , __ _.. ... ... .. <br /> ::.... . .. .. . . .. . <br /> IF <br /> ated Faeiff a antl,B'tg d r�ens U.S. EPAlC Number <br /> � Aw <br /> � <br /> tt <br /> &Fhone P r .� o : <br /> �• 9. , <br /> 9a. . 9b;U,S. COT De;cnp (on ( nctuding Proxr $hl�ptra� Name HazaM Class IC Nurnher 1+J.:Containars : 11 ;Total 12r �fntt '13. Waste Codes <br /> iid Fr <br /> ti _ : and Packing Group (if any)) No Type Qtiandty WLN01Fr 9 <br /> Ftl Ir <br /> Cj Frq <br /> >: <br /> !91 � : <br /> LU . _.. <br /> Z ,.. .: : <br /> , : : yy <br /> tFrep , <br /> LU! . . u <br /> FF <br /> M <br /> Fer <br /> . _. .. . <br /> _ _ <br /> Ft: kB : 'l0 <br /> tt <br /> ... . ., <br /> ...... ... <br /> 4 <br /> Z.} waw 3 . <br /> .. ,: <br /> Ft <br /> Fr I <br /> id Spe�al rlard1t tg n�6iictlats and Add trona! E idrmahan " YFr FIFF+: <br /> 6 Fr <br /> Mi=D 6 1 "too, I <br /> RN <br /> 69, <br /> 96 v <br /> a <br /> .: . . . <br /> 1a : GENERA70R'SIOFFEROR'S CERTIFICATION. , hereby declare that the contents of this consignment are full} and accurately described above by the proper shipping name, and are classified, Packagedi <br /> marked and tabeied'placajded, and are in all respects in proper condition for transport aceerdrg :o applicable International and national governmental reguiations;.if export shipment and I am the Primary <br /> Exporter, t certify that ttte contents of L% consignment conform to the terms of the aftacl`ed ERAAcknoWledgment of Consent., 6 Ft <br /> .i '. <br /> f trat the waste m6timizagdn statement Identlfied inl6 CFR R 3 (a tam a Ea ge t�*' fy generated a {t} pfie n a small quant lyyonertor) is fma <br /> e eratofsOf`starPrinted,7ypeti Name _ ' _. 5tpttUtt �y <br /> s <br /> } ? <br /> ` w. FL , - <br /> 1G. interna lona! Sfilprtients. <br /> F. IJ <br /> 4 ort from U.S. Port of ent texil. <br /> Import <br /> td U,S clip ry <br /> Z Transpa4ersignature. (fix exportsonEy) Qateleatingtl.S , <br /> ' i7 TransporlerA ItnovledgntentofReceiptofMa<erf�s ........ .. <br /> ::: <br /> U1 <br /> %61 1 tbd(T x _ I.- <br /> SignatureA9ofiiit dad #air <br /> a <br /> s s r,Ir , f <br /> e, <br /> z ; ans}xiiter : not ' fT erne ynatu fiXiit# C3s;r 1`@ , <br /> c> ; <br /> fY <br /> h ' :. _ . _ _ ...__. <br /> 1t1 Crscrepancy <br /> F. <br /> _ .. . El Partial-18a. Discrepancy Indicailon Space 0 Quantity El Type ❑ Residue El Partial Rejection ❑ Full Rejection <br /> - <br /> _ . _ .._ _.. .. . . . . ..... <br /> _ .:. Aanifn? Refaiense . tuber <br /> r U.S: EPA IC Number.. <br /> 18b. Altem9.e FacilityorGenerator) <br /> (.. . <br /> a <br /> C? t . <br /> u Fa 'Illy's Phone: <br /> '. ft:Signature otAfetnalsFa" ity (orGc#'W7forj IF .. _ FAor my ear <br /> a96 <br /> 19. Hazardous Waste Report faJnn ai;; lm.;thod Codes :cotles fd , an3dtts vraste treatme t ill f and: sfems <br /> .. <br /> 1�._ _. .r. .:. ... ... ) 6._. . . I <br /> UJ { <br /> IF <br /> 19.6 9 <br /> 1 6 <br /> 2t7 nesignated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as nded n tem 18a <br /> me YPa erne t r _FFL S�gnfituie n h Cay ear jI <br /> z j t aI <br /> atA <br /> Fr tL <br /> r f64 <br /> ' .:. <br /> EPA' Form 8700-22 O5) Previous editions are obsolete. <br /> ` . �; Tt:2AA9Sl=+t)C3 t I~W ;i t~C3F?Y i <br />