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Pip-ase print or type,(Form des
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<br /> U141FORM HAZARDOUS I:i,�-P�en��q,' 11 --- 2 ace 1 of 4,Manifest Tracking Number
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<br /> WASTE MANIFEST 011392828 FLEI
<br /> o,��ene,F'V's NaMe and Mat"no Address
<br /> G-^erator,s 3:.e Address JF giffee,i'h�-n mailing aftew
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<br /> Genera
<br /> mpti,; -.--!'REEY WE:-" �--'REET
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<br /> Gaie.a pr's phone:
<br /> riy Name
<br /> C- Was v, u.C.ERA 10 NLmbar
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<br /> 7.Traclocrfer 2 Canipany Name f U EPP,0 Nurnbl-.-
<br /> 77e,ionatcd Facilii/Name and Site Address Y.1DC N+jme,l�
<br /> U.S PA
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<br /> �4 168
<br /> iv,Phone i`755'` t-', E,
<br /> i'. Total 2 Unit des
<br /> and?ac ng Group(if ar.0) . %Viasle
<br /> HNI No Vduvol
<br /> Nor-, RCIRP na.zardouit waste, liq,'Jid t;JCOTIGIUPIGY` IM15-
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<br /> 14.Speda'Hfandiirig I.,.structicris and AdJiti0ral 1. 11 10524 090n--RC-r.iw ,-Aquid Waste £CA Cmily)
<br /> GENERATOR'SfOFFEROR'SCERTIFICATiON: thereby deciare:hat the contents of!Ns consignment are fuHy and accurately described above by the proper shipping name.andd are.^.fass:iied.packs Ed
<br /> ma,ked and labeled/0'.-carded,and are in a'!respects in proper concM.ion for translo i I aperding app=licable international regulations. "export snip nentand amthe Pnnlalt'y
<br /> Exporter,1 Certify bra,Lheconients of this consignment to a
<br /> inment c3r..'orm t e terms of the attached EPA Acknowledgment of Consent
<br /> 1 ra-iffy that the waste minirlization statement denin 40 CFR 262.27(a)("I am a larce quantity generator)or(lb)(if 1 am a
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<br /> �eneraE s7 a a nwmm Name , ay
<br /> r4on 0 D Year
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<br /> IF, -7
<br /> imPoR to U.S. i Export from U.S. port of cr.try/exi,
<br /> Transputer siggnature exports only" Date leaving U.S.:
<br /> 17,Transporter Acknowledgment oReceipt of klaterials
<br /> Printed/Typed Name
<br /> Mlontq ua,�, Year
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<br /> COL K-i s o ph e r A i m—An za
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<br /> ;E Transporte,2 Printed;'typed Name binn N.Qnlf, Dav Yea,
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<br /> 18.DiscrePancy
<br /> (8a.Disciepancy Indication Space
<br /> "Quami'y Ty p a Residue
<br /> tia,Rejectol-I !-,.j Ful'Rejection
<br /> Manifest Refeie;,,ce Number;
<br /> ti l8b.,"v-1erriate Fadi";(or Generators
<br /> J,S,CPA DiNumbei
<br /> Fac "'I
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<br /> F4�a 77 of A�tmaie Facility foiGenerator) f,,Iorth Day ya&�'
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<br /> FJ5 19,Hazardous�Alast--Re,6pon,61Aa.--,agen,,e,IT%Aethod Cc-des(i.e..codes for hazardous waste Yeatment:disposal,and recycling system,$)
<br /> 12. 3. 14
<br /> 20.Designated Facility Ov,.mer or Operator Certification of.f receipt of hazardous materials a I IS cov--'ea by the manifest ex-c ptas noted In Item 18a
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<br /> EPA"Form 8700-22(Rev, Fre 'j s editions aara obsolete.
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