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<br /> UNVORmHAZARDOUS j".Ger en@'(j-ID\I
<br /> of 3,Errieraency Respo,se Pho�c, 4.Manifes'Track;n,',Num ber
<br /> E MANiFEST
<br /> 011886360 FLE
<br /> 3-Gcnanq oi's Narne 3nailinq Ad dress Gen 9�a tor S i Add ess IT I =I a t tr.a:`m a I I o a.„ores s
<br /> Generator's PlOne.
<br /> -Fqoi2i •
<br /> I'-ompany,11anne S EPA IDP riber
<br /> 2
<br /> 7 -PA NMI)
<br /> Dcsignaicc�acijitytilamc End 619 Address
<br /> U., ERa ID Numb-
<br /> Facili_ta.Phone: i
<br /> 9a, 91b.U.S.DOT Description(includlrg Proper Shipftig Name.Hazard Class,ID Number. SD Cor
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<br /> -t;y,, and Pecking Group(.f aryl) V
<br /> 12 Unit j. vas[e Cocas
<br /> No. 77— Quai,t v, o.
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<br /> GENERAMRSIOFFEROKS CERTIFICATION: I hereby dee the't!Icorttents of this consignment are';ully and accurate'y described above by the Qroper shmpir-g name,and a•a classified.paci
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<br /> d an �jej�
<br /> placarded,ard are n a'!respects In proper dit.on fOr transport according to applicable nternational and national Bove_n[rertal reg!j,ationS e
<br /> X .1 k!-e D,!Tsq,
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<br /> shioment a,d 1_rn v
<br /> Is contents of this consig!,,rnem coi fomn to ifle terms 0;1 a attached SPA Acknowledgment of Consent.
<br /> iia;h I a I :
<br /> hat'a waste mnim aflon s!tement identified 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quar,01y geoerato,,;.]s tr ie.
<br /> C-e ator ntearryped 4anne 7
<br /> 51grz.ure Mortri Day Year
<br /> :6. rte rational SNpments
<br /> Imoor,to L"S.
<br /> L7_Export from U.S. FrAof ea(k,4it:
<br /> 7ransoorer signatune:nor expor's onlyl_ Da s)f4inc
<br /> ?7,T,,.-i,,spc.,rte:-i,,-kno,,viedgrr.erI of Receip'of Maie'10.s
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<br /> Transport,1 Pr-MeT
<br /> I'PeO Name /
<br /> SIG nature Day —7ear
<br /> 0
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<br /> ;r- Tirensprrer 2 PrF
<br /> Mont! Year
<br /> '8L Discrepancy
<br /> Sa.Discrmrancy Ind:,ation Space
<br /> QLani.
<br /> __j e Res.A
<br /> Type Pa ;ejpnon L Fu -U-0ri
<br /> ll Rciec
<br /> Manifest Referen,eNumbel-r
<br /> 18b.AlIsmate Facllity(rii Ger,.e-I,,cF)
<br /> S.EPA iD dumber
<br /> Phonc:
<br /> w slanatu,e otAlternatc Faic,iti;777ejere4to r)
<br /> Mori,: Day Year
<br /> I Hazardous'A"astl Report Nlanagement Method Codes(i.p.,codes hazardous,,vaste disposal,and recycling systems)
<br /> 2.
<br /> 14,
<br /> T
<br /> K ed
<br /> F' Des ig Tat .Facilt�,,,0,,vner or ODerator:Certilic-ation.-of receipt of hazardous mat terials covered by the manifest except as-noted' itern.2a
<br /> ri'n"'d ocd.N ne
<br /> Signature Year
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<br /> J cA�A_
<br /> E' it,Fo'i 8!00-22(Rev.3-1W Hrevicus editions are oosdef_
<br /> 7
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