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M I I I I 00 <br /> 000zT C) zT <br /> v 000 (D O m <br /> NCfl000 0 --1 - 0 <br /> - - Cfl = v = ONa) <br /> O O O <br /> W Wv� v * * — Z$ <br /> 0 -r�, 0 — 5' a) (O � <br /> Q 4�, W -Ph,CC WCO V 0 <br /> O 07 <br /> N <br /> fllCn <br /> / CD i�3 <br /> cn peA"nl or type.IFnrm aaslgned ler N W OOr <br /> ORM N 1.Generale.rD (z- )I \ \ <br /> UMF AZAROOUS 1 pt1Pn 0 7 0 <br /> WASTE MANIFEST Numpps pawrilorj 00 0 :3 <br /> - cC ralnrs Name and'-"'I Add, c 3 <br /> r aa� Emerµ:rxy <br /> ' <br /> "�'^ 0 0 <br /> 00` n <br /> a��m1�5P ena �a�e�.shnAad�„a _` 4 DAT G) G) <br /> srnnscoderfcompanr Name �a°��-x.-.,�.. G) (n � <br /> DO <br /> rraoevanerzcnmaanr Name N N —4 :E U) <br /> � UTNCD 7 W <br /> v W -P' (D 0 <br /> CD <br /> edesignamd Fanl4 I• Fca',�v�r I <br /> Y Name and Sile Address ti+ <br /> � L <br /> FaGlily'S Phone' • 0 Cl) <br /> I35 EeR IG Nu-.p. `/ Q Q O <br /> .11 and 1-e,g Gu engGan�includ ng Pmper ShiPAin �. O <br /> P Iran _ <br /> O r g Name.Hazard Cfass.rD Number D 0 <br /> 10 Conla- 0 � <br /> WNe Ty. Ouandry ftry 't Jam+ r--F ^ <br /> #g v D <br /> 4t L <br /> 3 <br /> _ Q <br /> 4 0 <br /> n <br /> 14.Special Handling fnsWplions and Atltlruonal Irt(om�a lion � <br /> I � <br /> 0 <br /> 15. GENERA d I.IDFFEROR'S CERTlFICgTII I hereby declare Nat the mnlenk o!Ihls cronsignmenl are full <br /> marked antl labeled/placarded,and are in all respects in <br /> E Porter I certify Naf the contents of this consignment conformrlo 11,14 r f o of the attached EPq <br /> CD <br /> rtdy Na[}he waste miaation statement identlfietl in 46 CFR 2fi2.27 a r em a le y and accurately descnbetl abwa by the proper Shlpplrg name and <br /> I ce g b applicable internalionaland national Q- <br /> GeneraNrs/Gryemra Printed? /I(I Acknowle191 of Consent. 9ovemmenlal regdot,o,s.If exq� � a PeorageG I I (D <br /> YPed Hartle rga quantiryganerator)cr(b)(itl am a wne�1 and I sv P'r' � <br /> small quantity generator)is true, I O 0 <br /> 16.fatemabonal Shipments Signature O O <br /> innsporter signat <br /> Import to U_5 <br /> -p,. Ma,h Da'r y�y CT <br /> ure(forexports oNyl. 0 N <br /> 17 Trans orterAcknpwled menl P(R Export hom U.S. Port of enlryleHA. _ 0 <br /> W P B <br /> O Transporter 1 Printed/T ecelpt9fMatedals Dateleavrng US.'� — CD <br /> YPad Name <br /> IL � 0 <br /> Qr� - Signature CO 00 (7 <br /> "'SaDrter 2 punt6allyped Name U <br /> Ma m er () Cf) ;q:~ Signature o 0 <br /> 18.Discrepancy <br /> 'Be Discrepancy Indication Space Lar YM -a Z: <br /> Quantify O W <br /> Type N � <br /> ❑Residue � <br /> 7Bb.Alfemate Faciil ❑Paroal Rjectione1 <br /> fY(or Generetor) C Fa¢Rmn <br /> Cl) Mantes!Reference Number Cy)^ <br /> aQ Facllrry's Pnone. U.S.EPA ID ^ <br /> real lac Signature oigRema Number <br /> to Facrh}yaor Generator) <br /> z —1 <br /> N <br /> m` ) azo dos waste Re rf Marta e,a Me hod v 01 <br /> 9 N d7 <br /> g MrnU <br /> L Endes(i.e.,codes for hazardo <br /> us waste freafinen( Day Ypar Cn� <br /> ? disposal,and recycling systems� � <br /> 26 pe 3. <br /> sigRated Fadlily Ownerw GPera(or Cerlificalion of of hazardous malenals covered b <br /> Preceipt nn�TYAed Name <br /> y the manifest except as nded in Item 4 <br /> 18a <br /> PA Fonn 8700-22(Rev.3-05)Previous""Ions are obsolete, Signa are <br /> Month pay Yaar n (D <br /> C. 0 <br /> GENERATOR'S INITIAL.COPY I � <br /> � = O <br /> CD <br /> N <br /> 0 O <br /> O Cn W <br /> 00 <br /> — (D 0 <br /> v O <br /> O 00 <br />