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Please ni or Form deafforUse On elite 12 itch iypawAlor,) 0 0 6 5 1 3 7 6 5 <br /> Fon <br /> IUNIFORMHAZAADOUS 2.Page -- Approved.OMB Na.2DSD-%39 <br /> No r <br /> WASTE WASTE MANIFEST <br /> 5,GaffiraweSNaftandMalIJng--d h -MOsnifaat651§765 SKS <br /> Ganer"s SM Addr$ss(1—(4%---t <br /> 7 10 a& <br /> 951 <br /> 9 70-:r <br /> 6.Transporter I Company Name <br /> .S. IA mbar <br /> Z.Thanspwor 2 Coqany Mro U.B. PA ID Number <br /> !71-r�li-1 1-W,1!7RI'jPr3 <br /> TMIgnal ed F,1011�Name and Silo Address <br /> t 4 t�1)j 0, <br /> 11;Jf1N HAPPOPS ,1.m U.S.EPA ID Nwbu <br /> PI <br /> PP PMTI�r"A T?lJ-.qj? <br /> SAN if)FT, <br /> Facill(s plow <br /> ga. 9b.U.S.C07 Desulplion(in0qdInq P(operShippInillfarre,Hazard Claes,ID NwAM lo. nars <br /> Hm aadPacKrgGmvpl[dany)) rAts[nIt.TWO 72,LW <br /> 17.Waste Codas <br /> HA7ARPOLIS WASTE- ROt Tt1q, f!IWI) wanay wiml. <br /> 2. <br /> 4, <br /> 14.SpLadal Aandlhg inalmegard;and Addrma[Iftwoon <br /> P4 lip F-M(Z.17f;!:'';!y it,"flo al-1 7c:u,, (cm s!u 1 Igo I ff <br /> I hereby declare Dial Wo6nk"RSGIW6o6 <br /> wu y a bY 010 06pb(8WnC name,$—ril-—dallft,padagd. <br /> ma*ad 001 WeledlOcarded.and Are In al respecis In proper MWkI)n JW tnSfi%)0d govordWit 100 applimble Jntaffnajllmlard national gavemmerm regulations,if expod shonent and I am N P" <br /> Exporter, <br /> I affluiy that the waste r"'AIMI.M1193 slalament Idergill6d In 40 CFR 262.27la)Ili I am a large q-"90110FAT)Or(b)PI I ion 0 Small quwft 90814tDd[3 IrU0. <br /> 'vw.rStoesios&roe5 lypamw Signears- <br /> ie.wernaliend 5hwenis14 15 11K <br /> El 1. Itto Us. Bw(Mm U.& Pcd0f1M*hl: <br /> Trampoftr slgnalure(for wWA onl& Dab leavingUS; <br /> 17.TraNp0fWAdm0*0r1grrarddRece0 d Meiarl&ls <br /> Printo mo <br /> mhos hicnin —Vk—yy*N <br /> 21 Tmns&W "K!in yp <br /> 15F Signalgre Monti Day Year <br /> 18.Discrepancy <br /> DIMPm Indkatcn Space ❑ <br /> Quandily RW4. El Me)Rujmdon <br /> U.S.EPA ID Number <br /> Eallftm—1. <br /> 19,Hazardous Waste IReportlUanNoo"wrt ethod Cadfiql.e.,OAS Wtutzardms wQA hadnank OYSM1.and("kViplams) <br /> a. 4. <br /> ore 6 fu <br /> a <br /> an y <br /> U-22-1 R, di& <br /> reabso DESIGNATED CILITY STINATION STATE'(IF REQUIRED) <br />