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L -0 CY) <br /> zy- — Cr <br /> O o se cn <br /> z om <br /> 437 O <br /> y <br /> s er nY $Y$1—ql �'N Tr� ` .r1 i`'w''0 '�Ar,a. Em+namm"""va0ctFnax ndw OD —hz CNs0?D <br /> IT 2 S/S o 0 <br /> Name C D <br /> = t < <br /> n DesignatedF iERN �1ARBQRS ENV SVC <br /> acilly-Na me <br /> C and Sile Address user^rA nu,nna, 'i 01:1 CD <br /> CLEAN HARBORS Tx C <br /> EJIIVXI?El ii "s eaninxvmnar 008Y205 <br /> KrrtBAit."I�HwAY 7, V-NT 0+ <br /> Facility's Pfrone� 30L]—�35'401� _ SEgV xCE$, 1N O <br /> U.S.EPAIp�N ��39322250 �9a. gh, vmher <br /> uar ooroes,ip,u r f,9145 <br /> P nclu S <br /> HM 1 and Packing Group(ii anyl� ding P�'�Shipping Name,Hazard Class,In Number, � <br /> p k3175 WASTE NF.g9BY723513 v <br /> LAJ+1JMy J E LIQUID-IDIS CTINTAF to-conlaiaes <br /> �1FD Nihl6 No. a 117n1a1 unit <br /> w BENZENE), 4. N'0•�, ICAS Yv ouantnq NI Na 1a waste Cn4ea O <br /> w �, V I I OL I Nr, nlq $ c <br /> r.' <br /> C7 _ r' D01 H 352 <br /> r -po <br /> ar <br /> r-r <br /> rD <br /> 3 <br /> ar <br /> rD <br /> r+ <br /> O <br /> 4,Speeial Handling Inslmcpons O <br /> arid Additional InFormalion � <br /> T 1.)sKF' H@54334! CIE3'277 CSG: 0000 <br /> 1�ERG*t�3• Ln <br /> P4H �Rg.N':Yti 00-46S-1760-•CHIsK/TFI—Corrtract retained by generator confers: a ency a-tt�ori W <br /> on initiat trans vrter to add or substitute Additional raro-s rt <br /> 15. GENERATOR'S10FFER0R`S CERTIFICATION: I hereby declare Ihat he contents of This consi nment are lull and ac urafel described above b the ro er shipping name,anti are c asshed,pac ed,9 Y 4 Y Y P P PP g 11e'9 <br /> marked and la6eladt�lacarded,and are in all respects in proper condition for transport according to applicable lnlema[anaiand national govemmentaY regulations.if export shipment and I am the Primary Ln <br /> Exporter I certify that fie conlanls Of this consignment conform to the terms of the attached EPA Acknowledgme of Conse . <br /> 1 certify that the waste minimization statement identified in 40 CER 262-27(a)(if 1 am a large quantity generator N <br /> (E}IN a small quantity generator!is true- Qj <br /> C,aoer�loK`e7i9ffenXs Pnnia[flTppyped Name Sig a Month Day 'I <br /> � 10.intematienal Shipments _. <br /> cn <br /> ❑Import to U.5 ❑Export from U,S- Port of eniglI <br /> Transporter signature(for exports only) Dale leaving U.S, < <br /> rD <br /> 17.TrarrsporterAdnowledgrnent of Receipt of Materials Q- <br /> T s r 1 Prinled/r !Ja Month gay ear <br /> YPe me fd J / Signature <br /> L <br /> L6t 1 <br /> Month 4ay Yeas O <br /> TwVorler_ '".ntedrTyped Name Slgna ure C <br /> It <br /> tv <br /> rn <br /> ta.Dlscre�ncy . <br /> I� 00 <br /> 18a.Discrepancy ln0cahon Space Quantdy Type <br /> ❑Residue Partial Rejection L S�u!l Reie <br /> ❑ ❑ <br /> Q <br /> Q <br /> Manil Reference Number. <br /> Ln <br /> lJ.S.EPA ID Number <br /> 8b-gltemale ,lur Generator! U.S, <br /> 7 <br /> N <br /> r-r <br /> rD <br /> IaRitysPhone Q:or`:s. ❑ay -, <br /> Signature of Aliemale Fadfty(of Genemlori <br /> O CD <br /> r r Q r7 <br /> Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) v a <br /> 2. <br /> 3. ° �° 3 <br /> ?signaled Facility Oww or Operalor Cerhficaton of ri3Dpipt of hazardous materials covered by the manifest except as noted in Ilem 18a �J <br /> TflypediVarne Signature a, o <br /> m 100 <br /> CDCD700-22 Rev. 12-17 Previous editions are obsolete MERAZORtS INI[ <br /> 793�/16 9 <br />