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M fA -UOp <br /> v m = � O <br /> N <br /> v f (D ONS <br /> o r 0CD <br /> N <br /> M. (n V <br /> CD <br /> v, 791 Ln <br /> N <br /> 00 <br /> v <br /> n <br /> CD <br /> 0 <br /> n <br /> 77 <br /> O <br /> � C7 <br /> w i <br /> D <br /> w I <br /> c� <br /> � I , <br /> C <br /> I <br /> aL.�n <br /> 15. GENERATOq'$IOFFEROR'S CERTIFICATION:I hereby dedare that bre contents ofmis consignmxntare fully and acaraFe�desrnbed above6 lne <br /> marked and lab that the cont and are in a31 respects in proper pondrpvn for parrs <br /> port Expxter. Cl that me contents of this consignment conform to the terms of the acurdurg d applicable intemaponalarq rational y ggper Pn4 raise <br /> I certify Thal Ina waste mirnmizaFion statement identfied in d0 CFR 262.21es, f i e a attached EPAAcknoWl�grr ent of Consent. 9ovemmental mgulaboi s-M export 'nem and i art,Cte Pre+ery <br /> G tato pyerors PrintodlFyped Name targe quantry gerreratvrj or(bj(iil am a small quantity generator) core <br /> �r <br /> 4RIeffiat,onal Shipments - I <br /> F` ❑Import to U <br /> ? Transporter sgnature(for exports only), LJ E+part from U.S. Purl of entrylexic <br /> w l7.Transporter Acknowledgment of Receipt of Materials Dale leaving U.S.: ---. <br /> 7ra7 <br /> poner 1 PrintetllTyped Name <br /> d Johnny Han-p-,- <br /> 'k <br /> lan pot sgnature <br /> Idonm <br /> z Tr porta rioted yped <br /> _ -) y1 Slgnatyre E�1 <br /> / ( �---- Month C;, <br /> t 9.Discrepancy -_ <br /> 183.Oiscmpancy tndicatnr,Space { <br /> ❑Quantity �Typa <br /> Residue <br /> ❑Partial Refecuvn <br /> I.,Generator) <br /> I8b.Alternate Facility Fuv <br /> Manilest Reference Numbar <br /> J <br /> [) U.S.EPA ID Numti,r <br /> uQ- <br /> Facility's Phone: <br /> w 18c Signature of Alternate Facility(or Generalvq <br /> Q <br /> 2 <br /> hbnm Da+ <br /> � i g Hasardovs a e Rev.d Management Method Codes tie..cvtles for hazardous waste Irealmenl.dlspvsal,and rec di <br /> C1, .I 7. Y ng ryatemsl C CD <br /> DO <br /> _... <br /> 20.Daslgnaty ar1[1 Owner or opalior CPrlilira6on of receipt of hazardous materials covered by the manHesl exre f <br /> nled yp Nama yt as noted In Ile, <br /> Pn <br /> EPA Form&7D-22(ItEv 12.171 Previous ed'rfions are obsolete' 0 - v <br /> � a O <br /> Cn <br /> - GNATED FACILITY TO GENERATORW <br /> C W <br /> CDD -4 19 SD0131Jy� CID <br /> N <br /> N <br /> v (n <br /> O <p <br /> W <br /> O <br />