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, . `.... ,. illl�lllllll�lliil <br />Pl.a,z. i,np tcnr, d—i—H .iii. i19­��rilpr <br />Fic, m Aorroved. OMI:i No. 2050-0039 <br />UNIFORM HAZARDOUS <br />It Gern Nun 2' age of 3 Emergency Response Phone 4. Manifest Tracking Number <br />008548655 F L E <br />WASTE MANIFEST <br />Gererat r's Name and Idatling Address Geriera'or's Site Address (if difflamrit than rnai71'nq address) <br />f i 12 t 3. 1 tI <br />Garmnators Phone: <br />6 T;anWoirleir I Company Name U.S. EPA, 'D Number <br />7 Transporter 2 Company 'Name U.S. EPA 0 Number <br />8. Designated Facility Name and Site Address Q1 E `' Dt I C. 3I V 1 0 1-1 Tri L? t A L tri LJ_ U.S- ERi\ ID Number <br />1 8b -W k <br />raciii.s Phone, J 16 6 H JJ! -J 6 Oil L <br />gal, <br />& U.S. DOT DeSgpticr (Including Prcpe, Shipping Name, Hazard "lass, lDINumber, <br />10, Cartel ers <br />11. Total <br />12. Unit <br />HNI <br />and Packing Group any)) <br />Quantity <br />wf.Piol. <br />13. Waste Codes <br />Nc� <br />Type <br />J i_21.i_21. _I'S it. <br />wa <br />1k 042 <br />P <br />IM <br />J. <br />-3 <br />frilcohc-1). Ljz' <br />Cr <br />LU <br />2. t-: Ift if, 0_k.` 1 r�. L,_j �p i 'L <br />Ll <br />.33 <br />D IL <br />LLI <br />. <br />3. r J� n i: F" C­�- <br />4. id <br />DF <br />t r , <br />K <br />14 Scecial Handing Instructions and.AdGit'onal information <br />L 01 Q <br />r li, F4 y 7 Wr CC, V C I I ii. C, Li <br />L. F1 tj <br />o., ci e Q; -A C. <br />GENERATORVOFFEROWS CERTIFICATION: I hereby declare 'hat the contents co":his consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />m <br />marked and labeled/placarded, and are in all res.P6,tsin Prccer condition fortranspon according to applicable int and nations' goverimental regulations. if expo t shipment and I am the Priman.j <br />Exporter, I certify that ft cDrtteffim of filtis consignment gx4ym to the Items of the arW0ed,§KArkrhuwiadgmaTa of Consent. <br />certify that the waste MinAmi7afion sjajerM�nt 4i�F p%zntity garifemV) ,c (b) (ifl am a small quantity generator) is true, <br />ir,�o CFR 262.27(a) (if I am q>f <br />;071ercr's Printadqyced Na5jvatWomb <br />'Day 'Year <br />to Export Port <br />ImPoft U.S. m U. S1. of entry/exit: <br />Transco -Iter signature (for exports oniyl: Date leaving U.S.: <br />17, Transporter Acknowledgment of Receipt of t0arenals <br />Transporter ter 1 PrintedirTvped Name Signature Nlontln Day Year <br />0 <br />0- <br />Z <br />Transporter 2 PrintediTyped Name ,3*TMure Montin Day year <br />ii <br />8. Discrepancy <br />18a. Discrepancy Indication Space QuantityType Residue 10 Partial ReJeetfor, = r-ui, Re,,ec*'V,. <br />Manifest Reference Number: <br />>_ <br />18b Afternate.-Facifity (or Generator U.S. EPA 1D Number <br />Facility's Phone; <br />LLJ <br />18c. Signature of Alternate Facility cr Generator) Mont, Day Year <br />19. Hlazaldous'vVaste Report M.anagement Method Codes (i.e, codes for hazardouswaste treatment, disposal, and recycling systems)W <br />LLJ <br />�\\LA\ <br />�A VA�tl�r <br />14 ��� t <br />20, Designated Fec."h, Owner or Operator: Cer*caiior. o�e4i. of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Flame Month Day Year <br />P , I <br />T -q I I z q <br />