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r r r 1-,"m oo0 � = 0', 0 <br /> v =3 - - — m <br /> OO — , 0NET <br /> N CD V V W O --1 O <br /> O -r�- -r�- W = 0 — <br /> c) 000 (0 � <br /> O C 0) 0) 05. <br /> rs V <br /> Q 3 (Q V *k <br /> O <br /> CD mmmv N <br /> M ,d �'� � 00 00� o <br /> _ t iirv �cnnn W <br /> o 00 00 0 K) <br /> w <br /> 00 00 D ry <br /> ..� r -.,,� 0D c m <br /> w Je e a ].E^wVwsY awry •. trd' 11uy� �\ <br /> 01INA561 FL <br /> r � O v <br /> CD <br /> M (D (Dcng <br /> e SEw. w � rnmm CD <br /> �amz w <br /> IS Ecn-,.. 0 r <br /> O � <br /> �e xhNameeM,.eeAtl�ms IZ <br /> S Ed <br /> 9hLLS <br /> • .. �° (n <br /> Q- O <br /> 3 0 <br /> as . 0.]roascmbon pnd Virg PmPar Ship¢�ng Name.HazaN Glass 16 <br /> HM O <br /> arhl addlnig CrrOur W.;'o, Nem6Br, W C+)ntame6 _ <br /> O C <br /> a O D <br /> w I O V1 <br /> z I Q <br /> O CD <br /> 0- <br /> 0 O <br /> C) <br /> O <br /> I � <br /> 74.Special handling Ms Wclions antl Atldirional 1nlermation O <br /> CD <br /> 7F. <br /> GENERATORS/OFFER CERTIFICATION;I hereby declare that the contents of Mi5 cronsgnment are luny antl accurately descdbetl above b the <br /> marked and labeled/placarded,and are in a1f respects in Proper condition for transport a=o In <br /> livable inlemational and natlonal � <br /> -,bfyt It the Matlde contents o7lhis consignment conform Eo the termsorlheatlached EPAgcknowledgmenlo(Consent. y proper shrpgng name acrd ared�drea <br /> go4emmental regWati Ile <br /> I m•rtry That Me waste minimization statement identiaed in 40 CFR 26227(al(it I am a is, <br /> quanti xPon sM1�n t arr6 D <br /> Genemlorsl0 erofs Pdnfed yped Name rygenerator or b) flama5mall uanli <br /> i oa ure I ( q h generator)Is true, <br /> 9 <br /> 16.Intemakonal Shipments 7 <br /> z ❑Impon to U.S. <br /> Trans orter si nature rot ex orfs onl �Expod from U.S. Port or entry/exit. � <br /> W 17 TranspaterAchnowledgmentof ReceiptorMaterials — - --- -- --- - <br /> Dale ea4j U.S.: <br /> O Trenspoder 1 Pnnled/Typed Name — <br /> b ..rgnahire �. <br /> ZZTransponer 2 Prrnreri/Typed ��' y a F <br /> a' Name <br /> >_ ignature <br /> I8.Discrepancy <br /> ern av aa. <br /> IEIa.Discrepancy Indication Space nn <br /> ❑Quantity LJ Type <br /> ❑Residue ❑Partial Rejection fr��1 <br /> L�Futl Releclnvt <br /> 186.Alternate Facility(or Generator) <br /> =+ Manifest Reference Number: <br /> a <br /> FaGli's Phone: US.EPA ID Number <br /> u- <br /> 18c,Signature of Alternate Facility for Generator) <br /> 19.Hazardous Waste Report Management Method Codes(r e.,codes for hazardous waste Ireatmenl,dis osal, Mond, Y r <br /> 2. P and recycling systems) <br /> 3, <br /> PO-Designated Facifil 0 J <br /> Y wner or Operator' <br /> 'rrMed?'YPed Name 'I'On y(he manifest nn of receipi of hazardous materials covered h n <br /> accept as noted in![em 1(la C:: (D <br /> gnalure C) <br /> D ° <br /> rm 8700-22(Rev.3.05)Previous editions are obsolete. By oar Q <br /> I _ <br /> � = O <br /> - GENERATOR'S INITIAL COPY N -0 <br /> CD o <br /> , (n o <br /> 4�, cD <br /> 0 41 <br />