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• • • / . � ' • / � : • • • 1 111 ' <br /> V1 , Generator ID Number margency esponse <br /> one, 1 ' <br /> _ f✓ Io Lj <br /> 5. <br /> • .Mailin r AdrGenerator's • ' • r different raddress). <br /> .. y <br /> r"I ) <br /> Generator' <br /> i J <br /> r • • • . r <br /> ebs <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 18, <br /> ice. Rftf%*,Name .and Site ' r • <br /> • Number <br /> 6300 Vadium Ek <br /> Phone:Kansas Uty MO 64129 <br /> 9b, U,S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br /> 13. Waste Codes <br /> and Packing Group (if any)) <br /> f / � ,t -' tai �. r " ;' - � {�; � •► • <br /> • • ecial Handling-Instructions-and- <br /> Additional Information1 ,i <br /> b. .. y iw + , <br /> 44 • i; • a <br /> 7. J , w <br /> marked15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified, packaged, <br /> .and labeled/placardedand . - • • proper condition . • • rt according to . • • . . . . • national governmental regulations. • r • and <br /> I am the Primary <br /> Exporter, • of • • nment conform to the terms of • • EPA Acknowledgment <br /> TransporterI certify that the waste minimization statement Identified in 40 CFR 262,27(a) (if I am a large quantity ge ratr) (b) (iflamosmallquan enerator) is true. <br /> Sign Month Da Year <br /> Generartfferors PrintedfTyped Na>�IIIIIIIIIIIIIIIII` <br /> 16, International Shipments El Import to U.S. Export fro rt of enTeMlrt. <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> A <4 NOR <br /> Transporter 2 Printedfryped Name Signature Month Day Year <br /> Month Day Year <br /> w <br /> . .tet <br /> 18, Discrepancy <br /> 18a. Discrepancy Indication Space <br /> El Quantity El Type Residue Partial Rejection Full Rejection <br /> : • , Generator) • Number <br /> Phone: <br /> 18c, Signature ofAltemate Facility (or Generator) Month Day Year <br /> rt <br /> , 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous matedals-co,vere-d by the manifest except as ncted in Item 18a <br /> ped Name Signature Month Day Year <br /> . , • . <br /> • <br /> 11 • • . • / • <br />