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em Approve OB No.105000, <br /> G�nc:atof ir2.Page of, 3,Emergency Response Pnrle 4.Manifest TrackingNumber <br /> ANiPPS:' i 013120750 FLE <br /> I.Ad ss'i' - an malflng address] <br /> GSfIe!au"!i N�-.me�-nd`dri�!! cll'aSs Generators Sl� Ad( e dffe,er,tlh <br /> r <br /> G p7onom; <br /> C(rMpan"', lame U S.EPAO N,77r� <br /> fa,,SPO-ier cnl Nil lj.S.�-PAA Numte, <br /> IZ- <br /> B.D= a ,d, Naqn-e in �Address U.S. 0 Num bar <br /> , <br /> Facq,'; �s Prione�- <br /> 'Da gs- '(1cl-, opsr Shipping Name,Hazard C12SS,0urtl <br /> Nber 10 Containers I -!Otal 12.Unit <br /> o -'04, �rO N 13 v'Jaste Codes <br /> apU U;'Vo!, <br /> r"I o Type Q a nt Y1 <br /> Q� <br /> 0 <br /> LLJ <br /> z <br /> Ls <br /> is <br /> 14 sr,717il Handkg nswiors an'Adoitional morniation <br /> GENERATOR'S/OFFF.FJOR5S CERT I,FJc;A.-!ON: 1 hereby dSciave'flat the contents of this consignment,are fully and accurately described above by the proper shipping name.and are d2ssified,packaged. <br /> eo ad ja <br /> -ded, no, appl�cableinte,nafto.nala-,idnaiio,,,algovernmertal,egLIei.tions,ifexpor,,shipmer,,t.gndiar-,t.ier N <br /> laoai 'd a6 al,res -di <br /> tt,acc iGn' ol�H,s -t—IV,the terms ofthe attached EPAAcknoMedgme:'of Concert <br /> pcvtor.I oqr�lili't�a U: ,, �s .rorsignment co;6"I, M <br /> I Oerl-ilb,That ih2S, mlininniZation stat sment:denJf�ed in 410 CFP 262.27(a)irf I am a large quantity generator)or(tQ(ifl am a small yantity generator)is true. <br /> GempV�Nrorls�P6 me iglature Month Day Year <br /> Y, WOE <br /> Snip-i-.e,ts <br /> Ex -MAJ S. o;a- <br /> port fro Pon mirylev': <br /> Tran soorte- e exoorzs Date leaving LIS <br /> CG I AcII�,,,`6cLmd--nt�i'�ecc,,z o�'01aiprials <br /> 7ran3po <br /> Year <br /> T,Srsooi io�edl�l si�lnatul i'vion-th Day <br /> 0 <br /> c-- <br /> Transporte-2 PrmtccdiTyo!d Nanne Month Day Year <br /> 18.Dksc,z-,Jarc. <br /> Type L__j Pn!,aL Rej_1 <br /> "e'a, Quaf iV Lj F]Residue 1-1:Retection <br /> Reference Number: <br /> -i naie-7-1; ,- .e:2tcr) <br /> U.S.EPA 10 Number <br /> Li- Facili. <br /> a f,oE G-nerator) Morth Day year <br /> z <br /> .9.HazalcOLS vNIaste Repot Me"ned Codes fle-,codes for hazardous treatment,disposal:and rer�ding systems) <br /> UJI3. 4 <br /> 20.iDc•s6cnate:-1-a i':i-Oamr ol Cat kalion oi receipt c.;nazalous materiats covered by trle manlfe-,Gxcn-P,as nosed In 1+,�yzi.�a <br /> 'N gnatuna Month <br /> cwolvi <br /> DA c)m 7 0 0-22 1; 2--.7 `1cis are O'Iscei <br />