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Pfeass print or#ype.' Fvm1 Approved,pi�4B No;2U5D-tiQ39 <br /> 1.Genwalor lD N.umher ?. e 1 of 8.Ems a fie <br /> UNIFORM HAZARDOUS. Pa9 rg ncy. spmg Phone 4.Manif t T c99b2.45 <br /> C-- <br /> WA$FENt4NIfEST �-)LO,21,`-i,;;f1; _, . � FLE <br /> 5:.Generatoes Name.and Mailing Address Geheralors Sit,mreasif differant.lhan;mai€irrg:address] <br /> Generators Phone: <br /> 8-Transporter.!Company Nims Number- <br /> U.5,EPA 1RNumber <br /> n 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name arrd.SileAddrass:,: U,S.EFkJD Number <br /> '+ <br /> FadflVs Phonal - "i<.lr <br /> 9a. 96:US..DOT Descriptdori[Including Proper Shipping Name,H rd CIess,ID Nuinbe,. t0.Conti' <br /> HM and Packing Group{df any)] 11.Total 12.Unit 13,Waste Codes <br /> pp ��•• Py No. Type quantity "ML <br /> 'JNFt S'�s�r?i-y S[S„��I:'•(.j 91: iL' .:.�, ri r- :: <br /> .� �2f,� .-.k .^i I•liJe7'-�rlti`r ;N :• 9 <br /> .� .. <br /> 3. <br /> 4. <br /> 14,.Spacial Handling InstrUoOnS andAddiponal.Infonnajtfon <br /> is }.�.�.. ”.>` .. `i i f i •I'.„: : <br /> 45. GEN ERATOR'SfOFFEROWS CERTIFICATION:I hereby declare V at the contents of anis mrtsignmerlt are fudty and accuratelydes tred afiove lFte <br /> marke i and.labeledlplacardad,and are In all respscls in proper Rion for Irons by prow shipping name,and arAclassifed,packaged, <br /> port eo�Ing to app€Icable Irltemationeland nation govemmenfal.regulations.If export Shrpm Mand!am the Primiry <br /> 1 xWer,E oe tlfy fiiat N contents of(Ks mnSignmentconform to #arms of th8_attached EPA . <br /> +4ehrrowledgmenl of Consent. <br /> I c rlity that the Waste miaimixatlpn stalement idsnfified irr 40 CFR 2 iZ27(a)Of I aria large quarility..gai aralor) dI am a.smap nflty generator]is.hue, <br /> Genera O s PrDnledlfgped Name SI na <br /> fdonlh ❑ay Year <br /> _j 1i3 !Dona}.hrpmentsx. ::`r <br /> %- ❑Import to U.S. ❑Export f U.S: Port of ani xit: <br /> ransportersgnahare.([orexporfsonly]: <br /> Data J.s.!: <br /> a7.T.rauparberAcknawledgmentofReeeiptaffAateriats. <br /> Transporter 1 PrintodrIyped Name <br /> C] S naluaa <br /> Month Day Year-' <br /> Transpa tart Prinfedlfyped NaMe <br /> 9Signaure M18a.Discrepancy Indieafiwi Space ❑ Quantity ❑Type ❑Resid ❑ParGa€Rejeetlon <br /> �_ 186.:A1terriate Faa1 ry{or GeneratarJ Manifest Reference N ber. <br /> '1 U.S,EPA ID Number <br /> U <br /> uQ- Fat�IDE}Is.Phcne: <br /> W18c S gnalure of AksmaYe FaetRty(or Generahar) <br /> Month Day Year <br /> 19:Haxardcuis WLu aste RePOrt Management me.. Cod"sFa-,miles far rdotrs walla area <br /> t.. dtspasal,ad nacpdi+vg systems) <br /> 3: <br /> 4, <br /> r x 2tt,•Designated Facility Qymer or <br /> pperaton Certtficark<a of recadpt of matedafs covered by fie manifest a in m 1 <br /> f?r1I11eNi Name. <br /> &PAFvt'rn 87M22.{Rev:12-17) Previvus.ecifts are absaiete.. <br /> !]ESI. TES FAClLT.�EPA's a-MA lFE3 'SYSTE <br />