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M I I I I <br /> 0000 � = <br /> � 0 <br /> 7 <br /> c:) C) CD � OED v <br /> 7 - v 4d-- O --I <br /> v IQ» — — ON --j <br /> —n 000000 O �# cCD <br /> O Cfl OQ 0u <br /> O OOC9O 4p, C9 (D <br /> Q 00 -4000 O <br /> TI TI TI —n <br /> o rrrr <br /> mmmm v o <br /> M 1 a-a w <br /> = NN � � CD <br /> U) W W PQ <br /> 1�111111Nil 111111 gv1RNa:l`• : � � CO COPQ B <br /> Frmn m <br /> Please print or type.(Form designed for use on elite(12-pitch?lypewnler.) ��p'`b ^^ <br /> UNIFORM HAZARDOUS 1.Generemr ID Nomder 2.Page t al 3 Emergency Reel.Ia.Maneeal Trai:Nhp llumher ^ CT <br /> WASTE MANIFEST 010788907 FLE v <br /> s GPnerdlars Name and Mailing Address C—n ll See Addre:,it diherenl than malllrta aralm V 0 <br /> I Cn W W CD � <br /> IWv0 CD 7 <br /> Generators Phone. cil —— �` V <br /> ra,awls, —IName 11.5 EPA ID 1O cn <br /> O <br /> 7.TraesMrler 2 comvany Name 115.EPA ID NQn, CQ 0 <br /> G 0 <br /> 8 Designated Facility Name and Site Address V ber <br /> 5.EPA ID Num0^ <br /> D <br /> Facility's Phone: <br /> ga 9b.U.S DOTOescdption iinetetling Proper Shipping N—Haeard Class ID Number, III.Comer, 11,ictal 12 Unn <br /> HM and Paoeirg G-jajilanyjl No. Type Quantity WI Nd, 1Q N <br /> (D O <br /> O Q <br /> K 0 <br /> Z 'L <br /> n <br /> O <br /> 3 <br /> I � <br /> O <br /> CL <br /> O <br /> 14.Special Handling Instructions and Addinonai Information CD <br /> 7 <br /> a <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION',I hereby declare that the conlenlsal this consignment are fully antl accuratelydescrited above by the proper shipi name,and are clasirl pokage<c. OI <br /> marked end Iahaledlplacardad,and are in all respects in properwndifjon for Iranspor!according to applicable international and national governmental regulations.II export shipment and t am Lha Primal <br /> Eepoder, certilgthal the wnlenk of this consgnmenl conform to the Il <br /> the attached EPA Acknowledgment of Consent, <br /> I s,d"Nal the waste minlmilahnn statement.demi�ed m 4DCFR 262.27(a((if i am a large gNaofilp generator)or(h((if I am a small quanetygeneratorl is[me- (") <br /> enerata's70 rots nntedrlyped Name rgna ure " ay ex <br /> 16 intemalional Shipments <br /> 2 ❑Import to U.S. ❑Erpon from N.S. PortofentrylexiC <br /> Trans ner sl nature for es onl Dare i U-S: <br /> w 17.Translwdar A,Fnrywletlgmenl of Rprpiplof Materiels <br /> Transporter 1 Pnnledffyped Name Ignalure MI y <br /> O <br /> as Transpoeer 2 PnnledRyped Name I ignalum <br /> r <br /> } Ie.Discrepancy <br /> lll1l )8a.Olscrepancy krgrratian Spay <br /> ❑Uuanrilr ❑type ❑Residue ❑Partial Reject ❑RIAW selii <br /> F lLu'wiemale Ta[IVIy mr Generalwj Mani}est Referehoa Number <br /> LL0.5.EPA IO Number <br /> Fadin � <br /> lea" es <br /> � kAemaiefacrrtY for Genhagn <br /> � k1phM y alOr <br /> cm <br /> Wq li a�dVdelEP�n Nandgemenl Netnod CedE6II,e.,[qday ler haxaltleus wd5lB 1rBelmanl,disposal,8nd reeyellrvg Yyslem5} <br /> Pnn .i�irNaam,l�ly r`MiPr orCmeralol.Cedlflc shon0recolplW haaardVus materials Goreretl6 (D <br /> C7 <br /> OYDae manlleal rxcepl a.rglee in Ilam 18a O <br /> naWro Q <br /> EP6 For - 2iRev?951 Previous etlitiens are obsWele. ,i11 aa <br /> Ik'fk T <br /> CD <br /> � O <br /> O <br /> W <br /> W 00 <br /> v � <br /> v <br />