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M cn -0Ul0 <br /> v m _ - ° <br /> � o �' <br /> � m <br /> cka oo <br /> o �d S o 0 <br /> d' 3 M <br /> IT p1l hl rVpew rer 7 11111 1 111 C <br /> (n „ter<: 3 vat's t M 3 Errwpr:- Fran App,, ANE We <br /> 010740567 FSE00 <br /> .d�.r. m <br /> W <br /> N3,P 3 <br /> us EPa,rfl 3 <br /> m,a r Name 0) <br /> •_ SIS Eow.IL Ne�oe <br /> ",�" .gyred Faaery Norma and 5re Address j <br /> O <br /> faalir3's phme: � � <br /> pd.U.S.OOT Descnp'on[including proper Shipping Name,Hazard Class.ib Number, t O <br /> �°. and Parng GruuplNanyll 10 Containers <br /> Al '1 T3I 12 lher ' <br /> N. Type hranbty <br /> o D <br /> a <br /> � z I <br /> W <br /> f7 <br /> 3. <br /> 1 <br /> 4. <br /> 14.Speriat Handling Inshucrrons and Additional Information <br /> 15, GENERATOR'SIOFFEROR'S CERTfFICATION:I hereby declare that the contents of this conslgnment are fully and accurately described above by the proper shipping came,and are classied,pgp eyed <br /> marked and Isbeled/placarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shrpmenl and V am ete Pmraty <br /> Exporter,I oertity that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> Ice*that the waste minimization statemenl identified in 40 CFR 262.27(x)(if tarn a large quantity generator)or(b)(if I am a small quantity generator)is brie. <br /> Generatolsr erors Printedlfyped Name rgna ure a ,� <br /> 1&international shipments <br /> ❑Import to U.S. ❑Export from U.S. Ped M en1r,'erif <br /> c Frans ner snature for ex ds oN Gare?eavin U.S. <br /> 17.iransporterAcMowiedgment of Receipt of Materials <br /> Transporter I PrinledrTyped Name lgnature k1o,th _ <br /> Transporter 2 Printedffyped Name Signature <br /> 18.Discrepancy <br /> r8a.Discrepancy iodrea6on Space ❑ <br /> ❑Quantity ❑Type ❑Residue <br /> ❑Partial Retecbon Ful Papi <br /> Manifest Reference Number <br /> 1b-Alternate Facrliiy{or Generall U.S.EPA ID Nurneer <br /> ;iii s Phone: <br /> .Signatu a 4Alternate Facility(or Generalorl <br /> `,`r•r a tie,y C7 .ZJ <br /> C:: (D <br /> T C-) <br /> lazardous Wasle Report Management Method Codes(ve-codes for hazardous waste treatment,disposal,and recycling systems) > O <br /> 2. �- <br /> � <br /> v = � <br /> cc v <br /> s gnated Fac pity Owner orOperator:Ce tifica�ion of receipt of hazardous materials covered by the manifest except as noted in Item 18a N <br /> CU i 7vped Name C CD <br /> o Signature Month Det' �� W <br /> _ w <br /> CD <br /> 4�, 700-22(Rev.3.45) Previous editions are obsolete. 41 <br /> GENERATOR'S 1NMAL COP <br />