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Peas", ix n, 0, zyo Form A -proved, C`,13 Ne. 2050-009
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<br />is tons are obsolete.
<br />8700-22 (Rev 3-0-5) P,' v OuS
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<br />HAZAR'�OUS I G-n�—,,, ID i4jmber 2, Page I of 1 3 Ernsoency Response Flone
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<br />WAST- MANIFEST F
<br />011385113 FLE
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<br />Genal a .C,rs Nomeaar�, klailmg Address Genera; `s Ste Address (if dw-.1, rt I -,in rahing -iijdtessli
<br />,Phone: rA
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<br />8. Des gnat. Facility Name a-,..! Me Address
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<br />Fac ,, ,Phone'
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<br />Qb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID NumW,
<br />Q. Containers
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<br />12. !Unit
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<br />il, Handlkng ristructons and Additional Ww"ation
<br />15 GENERATOR'51OFFEROWS CERTIFICATION: 1 hereby declare that the contents of thi's consignment are fully and accurately described above by 'he proper sniipoing rarne: and
<br />ere classll-o. Pq-,l<aoso,
<br />marked and abe'eJ'-D'acardec, arid, are in all respects; in proper conation foi transport according to applicabie international and nai.onal governmental
<br />regu!auons, export shioinerl
<br />and I an the Primary
<br />t Censer`..
<br />po� e- 1 certify th � �he contents of -Ns onsion ent conform to tine terms of the attached EPA Acknovdedgmem of n
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<br />cartiry at the oiante min rrization statement identified in 40 CFR 262.2/(a) (if I am a large quantity generator) or (b) (if I arn, a small -quar.Z.1y generator) is true.
<br />—77-7
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<br />international Shipments Imp"It Export frot/i-j"s, For, of entry,'azit
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<br />I ransuorter signature (for exfjotsonly,1-' Dale savino,1U,S-:
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<br />7—ansporiel, I Printedilyped Name S,glature
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<br />18, Discrepancy
<br />Discrepancy Indication Space
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<br />S�n�� oft Alternate Fa�i!Ry �,r Generaor)
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<br />hazardous waste treatment, dis.pcsal, and systems;191, Hazardous ,"Jiste Method Codes (i.e.,, codes for
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<br />2-01. Denigrated Fac it Owner or Opera' r: Cetfication of;ec--ipt of hazardous materials by me .except as noted i. tem Ise
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<br />is tons are obsolete.
<br />8700-22 (Rev 3-0-5) P,' v OuS
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