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Tick 1.970'0*76 <br /> r S3E� Fi..':�: 't'4�.�1 nP#.c�+'a.7.D.•.r S..O. x'^H'%.i C57:a' r U�,"'xa7j,G <br /> i <br /> p` z+7tit <br /> 4 I <br /> r <br /> )„ v i�,YU19B1: � �: �h4'!',. t4cal>E <br /> 37+x} <jIfr�tR<;A -t 2 <br /> 1rt rl'due r. <br /> t`3Av'3.S;7FtA u ''�f <br /> a <br /> eil <br /> IliJ <br /> 4 '.�dll:✓1J'r!ry NtPs:�4`;��a ^1�P:vY7�di�4 RTAflTl CCflio-v�"', (���1 f�r /fit ,r � Y#v?yf"fi"ar"�1.�'1'i�- � `�s - �i�T" Ek'ii.�r �`�,{it! �'L+ v}r <br /> l; t r <br /> .. TCnsg�1. Argdarr-Yik x�`i"�.1 <br /> L <br /> V, <br /> �a <br /> gg tt � <br /> a <br /> g xn 7 r+ <br /> M57�3 s49Po9 ;�e Pnlfxatlonr�,.�1 ,,. ° <br /> 14.OENERATOR'SIOFFEROR'S CERTIFICATION.I hereby declare fi the contents of this consignment arefully and accurately described above by the proper shipirg mama and she classified,packaged, <br /> - marked and Iabriledlplacaelad and m all respects in proper condition for transport according to applicable international and national govargmental regulf0mrs. <br /> Generators+Offeroes:Ppnted/Typed Name { Signature J �' Month Dav Ysar <br /> 7r& r-. t 4)to "t <br /> 15.Internahonal Shipments / - <br /> _ _ ❑Impart to U.S. ❑Expert hom U.S. ` Pod of entry/exit -^°t <br /> Transporter Sinature for ex orts onl I Date leamc U,o <br /> w.1&r.TransportemkGkAowIedgnr aLRegeipUel-Maye[lals„ - <br /> Transpotteit PrmtadlTyped Name Signsiure ..Month Day Year <br /> a -Transporl 2 PrintaNTyped Name Signature Month Day Year <br /> 17.Discrepancy <br /> 17a Discrepancy Indication Space <br /> ❑Quantity ❑Type ❑Residue � ❑Pa9ial Re;adicn ❑Ful 9eleonon' <br /> Mandast Refe[aoce Nenber: <br /> I 176 Alternate Facility(or Gencrator). U S.EPA IP Ncril <br /> J <br /> U <br /> u Facilitys Phone _ <br /> w iZG Signature of Alternate haafity(or Ga erator) _ Monti Day, Year'. <br /> Q <br /> Z <br /> rn <br /> o <br /> 18.Designated Facility Owner or Operator:Codification o[receipl o•meleriels covered by the mandest except as Treat in It vp(a <br /> Pdntteyped Name / „$gnat e Month ea Ye- <br /> 169-BLS-05 11979(Rev.9/09) - - TRANSPORTER#1 <br />