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I' rentor typo.(Form daslflnod for use on elite(12- itch] p&N7itef] Form Appra'fed OMB No 21750-0039 <br /> UNIFORM HAZARDOUS j1,Gerlefa10-,f -Njirherd :d 0 O U u 2.Page 1 of ] {�Og61 s;ka-s tek anffQst Trasktng Numbor <br /> � O (2 <br /> WASTE MANIFEST (}} Q 17 68689 JJ K <br /> I:ClE4'iPANY Gendratar's S:e Ar dross 0 dilt6resl Um r;irai Ap addrass) <br /> Cxenbratgty AhUrit: <br /> 5 7rar4'li ngr 1r1,�1 N{�TIe U.S,EP? tiu'. <br /> .�,I{I.L1 5:131 ' PI':I�iLlt'It.�l.rJ l'!;I.:, ;'c If:t ; Q ,6 U-s i r 0,3 t' <br /> 1 rr'l19"'WI i .S,EPA Nunlber . <br /> S.DesI n�Ig�F�tiily{ r�aandSiWAddf%s US.EPAIDN[trbar <br /> r irr,�3L'�•Lis <br /> 21X,L 1311.it <br /> (siNiA rid 8133t>!5 <br /> ?y'tf tiane t'_126)344•!3826 <br /> as ab U S.DOT Descriplion('r,:fuainq Proper Sh•ps na Na-re,Hazard Ciass,ID Num ter, E0.con!ainers 11,Total 12.Uni! <br /> i 13.Waste Codes <br /> and P«ckng Group,f any)) No /TType Quantity wI AV,t`0zN-F 0,;A HA'0.'ARDCU:i 'r7<<i 11-1,14110 1 i V(13i;r1lif.l:1!i li'. +lirti�'I J[ :. F <br /> -j <br /> w <br /> 3 <br /> i<.SpeeN1 kinnrLng InarrutionsarldAddil�ar;al In[ormallvR � ��-��•�-� <br /> 1 1':t ';i f-f�lr-Y t'C[1'Itr11;T ¢;I[I'IGtTI�EC 1=1i0(3•�f�4l 9000 tS1>I 3'I`RIVRIAI, I`��'it F-ilrii(0C , J. :1 i'FiLiF1L C. <br /> *?,o79 SX�. <br /> t5 GENERATOFrSfOFFEROR'S CERTIMAT[ON: I tweby Garda d:h;t the contents of lh$consignment are fill{y and 8:wuialtly desra bed a�.Ane tq She proper shipping name,arO are vassifed,packaged, <br /> marrod anct labafadr aeardec•ono ata in a`respects in prape�coadit3on forranspori according;o applicable international ora national governmantal regu!at!ons.II expe c snlpmerd antl t arr the Primary <br /> Exporter,I Wi?y that the contents of Ihs consignment conform to;ha(arms or the arachad EPA AoknoMedgmentof Consent <br /> I certify!ha!Ino waa.W rtvnim!raf M slate[n arr!4enlifrad[n 40 CFR 2U-21(e)pf I em A Iargio quPtIly gonera[ar1 er(b].(!f I em a @mail quantity genera prJ's lrtre. <br /> r'ogerar a NnWdrfyped Name S t anal Day Year <br /> 'en u <br /> e <br /> J 1a,isterrelicna? hi ,eats i11II--''�� .^,of ant <br /> Import to U.S. i—i Exp;ri from U.S. <br /> z <br /> — Trarsparlei signature;fc':>t::;r;s on;?;, Curr reav�ng U.S <br /> 1?TraflS{.a�rA457lUniBdgrl'.PRI d�2Cllpl o';ialeria`=.� <br /> T[anbpo[I-r. ri gdfTgE11 iamc� <br /> Cak jiPE11L-1 f.'111 'i]7ay ��33r_ <br /> O <br /> tL <br /> z T[an5pc;!w2pr•Itedr7ypedl4n- +-�- Stgratu:e l chin DDay` Year <br /> 0t-1 . G °u <br /> 1!3 I7lacrepaneg <br /> 18a D:screpency Indication Space Quantity Type 11 Resfd,.* 0 Partial R.e(eclen ❑RA Fe action <br /> 'ani ast Roferonce N'umbe-� <br /> 'E:-Aftrrw,;FitCi•.ry•to G" nE:Oxi U.S.EPA ID Ktjmtier <br /> ..I <br /> U <br /> FalitPhcw <br /> LU <br /> 18_Signature OR lernale FawkP;(a Gwiati;r) mor" Day YE'lr <br /> G <br /> z <br /> 1fl.Hazatuus Nfas!e R2 varl Marosgemarnt htaln7d Udus(i.e.,codes for hazardous vmste treatment,disposal,and rog0ng sys!e,%s <br /> 0 1. j 2 3. 4, <br /> 1 <br /> q <br /> ---------------- <br /> 7 Gesiana'ed FaollCj Orner cr G eratcr:CedificaGcn of rete;ol of bozo acs meterals ccvered by 111,e manifest exc�as notea:n Item 18a <br /> Pirnf. ry d ma slut or.VS l'.., sV-.;, <br /> ,Y 1 <br /> EPA ru-m 870-221Rev 3.05} Previous vdtt enc are-obsolete Di=:i Cx(IIAI'LE] FACil 1)D STINKFION SIATE(ii=REQUfifE ) <br />