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T I I --i I I — D Tr O 0 <br /> I1-1 0oS ooO 0 <br /> � xO <br /> o � 100OoO � _ <br /> co00v <br /> D ocnocnrn � — - <br /> QO --j-n rnoo ooo �� 0000 <br /> o 00co00CD <br /> -n -n -n -n - w O <br /> o <br /> 17- 17- 3 r- r- zy <br /> = o -P,m i c��n00 -; —wQ1< o <br /> (n Plaase pnnt or g N W N L v <br /> UN OR type IForm tlesi ned for use on elite{12-pitch)typewnlerV Form Approved.WE No.2050-0034 N O � N O X� 00 <br /> M HA7ARDOU3 a-Generator ID Namber 2 Page 1 0} 3.Emergency geeponse Phnrrt C 01n11e11 Tracking Nemper O � C Q � o z <br /> WASTE MANIFEST 011410896 FLE �' �' �' N <br /> 5.Generators Neme antl Mdeln Address <br /> g Generalers Ile Add—es ddiaerenl Iliac maArng edd—e O <br /> CD cn CD CD <br /> Gerreralors Phone. (D 6 3 3 O <br /> mnapode ompany ame -, CD -0 0 <br /> CD <br /> U.S.EPA 10 Number01 3 =3 <br /> O O N O O w v <br /> O 0 00 O —1 <br /> T.Tranaponer2 Company Name U 5 EPA 10 Number _ � (D <br /> ^ C N 7 U) <br /> 8.peslgnaled Facplly Name and SdAd <br /> e dress 11.5.EPA 10 Number Il J Q In N O <br /> cn cn QCD77 <br /> N —' NO pg <br /> Facility's Phan.: 00 =3- 00 c: 0 0 <br /> W O W (1) <br /> — <br /> H and Fin.arg Geup(irof(inc!Wirg Proper Shipping Name,rraram Class,1p Number, m_Containers I1 Tofal t1 Vnn <br /> HM and Packing Group(ireny)) Na. Type 0—tity WI NGI "1e Eades �� Q D <br /> o o O <br /> (D <br /> cn <br /> Z 2. (D M CD <br /> O CTI <br /> o 3 <br /> Is_ 3 <br /> 73 <br /> O <br /> 3 CDCD <br /> 14.Special Handling fnsimcdonsandAddidonal lnfocnarioc r--e <br /> CD <br /> Q <br /> 1 1 N 1 <br /> 15. GENERATOR'SfOFFEROR'S CERTFFICATION,I hereby declare Iflal the—*Is of[hi-on—sign—t..fully and ar-lately descnbed above by In.prop—tripping name_antlare Gass!fietl.packager, O O � O U) <br /> marked and labeled1plecartled,and are in all respecls in proper epntlifian for Iranspon armraing to appltcabfe inemali <br /> tWard national governmental regulations.Ife.pon shrpbrenl and am me P—i n <br /> Eeparter,lcenify that the conlent5 of this mnsignment conform to the fertns of theattacnetl EPAAcknowletlgment of Consent. � � ,� � <br /> I certify That the waste minin,z n slat of idenfi6ed In 40 CFR 262.2T(a)(if I am a large quantity generator)or(bl(lf I am a smell quantity genermwr)is true � <br /> Generate to s nnle fry pe ame rpna ure s s <br /> on sy ea O O 7 O CD <br /> 00 00 00 � <br /> Intemalional Shipments C9 C9 C9 CD <br /> i– ❑lmpontous ❑Fxpohfmm0.s. Punnreolryleed: �l O� <br /> z Trans rler si nalare for es ns onl : __ 71 — <br /> Oateleavin 115_ r r`G• r O <br /> w 17.TransponarAcknowledgmem of Receipt of Materials � <br /> O Transporter 1 Pnnt�Mypetl Name Ignalure y ear M M M n <br /> n a o <br /> z Tramponer 2 PrimedRyped Neme ignature - <br /> anrh ar tear � � w <br /> F W W W � <br /> 1a.Oiscrepana N N N O <br /> 0 0 0 <br /> Ida.G'suepanty Intlication Space ❑On.* ❑Type <br /> El ❑Paroal Rele nnn ❑Fe gapcdpn Oo Oo 00 CCD <br /> O <br /> Manifest Reference Number_ '"� � <br /> }Bb Al lemate Faaliiy(or Ganemlgr} 11.5-EPA Ip Numher <br /> u (,—� G) <br /> Faoli'5 Phor1� <br /> w IBc.Segnate r nate Facility for Gene*alor) Cyr! Cyr! cn <br /> N N N <br /> ¢ c Mn"m Day a'bar 00 00 W <br /> Z <br /> H19.Haagyp Q Report Management McNod Codes li e.wtles for haeaidous waste Irealment,msposal.and recycling systems] N <br /> J =3CD <br /> 26 Gesgnale �M'ner or Operator'Certihmlion of receipt of haiardoa6 materials CONared by HIB maallast eacepl 8snplad in Item 18a c <br /> PnmedlTypedO igaature <br /> Meclh DaY rear <br /> C <br /> EPA Form 6700-27 f'� Sj Previous editions are obsolete. (D n <br /> �!X5) - IORSINIfIAL � o <br /> COPY <br /> (D T <br /> ( <br /> O CD �13 <br /> O <br /> O O (St <br /> W <br /> Of) v <br /> CD <br /> r-. v <br />