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ill <br /> CD = -4 o-0 <br /> CD N <br /> fll ! O O N o <br /> p _.r E3 * O N <br /> CD0 CID <br /> N <br /> Please I I I II I�II I]I I Farm Approved. No.2050A039 W <br /> ffl Pnntortype. II II �I�I I I <br /> OMB � � <br /> :111 <br /> Treckln Number W <br /> UNIFC)RMHgzARDQUS 1.GanElIDtr,mbr onse �4�29207 FLEeQ <br /> 2.Page 1 of 3.Emergancy RespCD ASTE MANIFEST ,r,/!� r, CD <br /> 5.GeneratoYs NameaSiteAddress(,fdiNeremailing addres) <br /> W <br /> Generalne'Phone: U S,EPA ID Number N <br /> 6 Transporter 1 Company Name .i l i 9 f i•' <br /> U.5.EPA ID Number m <br /> ?Transporter 2 Gom NName = <br /> N <br /> U.S.EPAID Number � <br /> S.Desgnaled Faolily Name and Site Adtlress'" �� � � i� q � <br /> 1 fH,o+" 3; CD <br /> tru.n, <br /> Cly X742 <br /> Feclli Phone <br /> pping <br /> 11.Total 12.Unit r <br /> ga. gb.U.5-DOT Description(including Proper5hiName,Hazard Class,ID Number, 10.Containers 13.Waste codes 0 <br /> HM and Packing Group(if any)) Nc Typo Quantity WLNoI- <br /> 1 Q0 <br /> 2Lu <br /> cn <br /> 0 <br /> a <br /> 4. <br /> 14.Spacial Handling Instructions and Additional Information <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION:I hereby declare that the call of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> u marked and lahaledlplararded,and are in al respects in proper condition for transport according to applicable intemati l and national governmental regulators.If export shipment and I am the Primary <br /> "YT Exporter.I certify Ilial the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certily Val the waste minimization statement idenbhed in 40 CFR 26227(a)(d I am a large quantity generator)or(b)(df am a small quantity generator)is true. <br /> Generator f i`S p rrWirr d Name Signature <br /> ,"p4 YPe '9 rl '5 ; Month Day Year <br /> J 16.International Shipments —I ' <br /> � Import to U.S. J Exgos im U.S. Pon oilersryfexit: <br /> $ Transporter signature{for exports onlyp, Dalelii ing U.S.: <br /> W 17,Transposer Acknowledgment of Receipt el Matenals <br /> iTrans oser 1 Pnntedli ed Name S-nature <br /> � P YP Month Day ye- <br /> 13- <br /> e <br /> Q , <br /> Z Transporter 2 PrinledJyrind Name Signature -" Month Day' Year <br /> Q <br /> all <br /> N <br /> to Discrepancy <br /> 163,Discrepancy Indication Space Quantile Typc ❑Residue <br /> ❑Partial Hall ❑Full Rejection <br /> Manifest Reference Number: <br /> 15h.Alternate Facility(or Generator) U.S.EIA ID <br /> C nU <br /> lu- Factlity'S Phone' D O <br /> IB,Signature df Alternate Facdrty(or Generator} Q <br /> w Month Day Year � <br /> 4 <br /> Z = <br /> t7 1g Ha2andous Waste Reppr Management Method Codes G e-codes for hazardeus waste treatment,disposal,and recyGmg systems} � � <br /> LJ 2. 4 N �l <br /> �O 1 Q O <br /> v y0 posqnaled Faptyfy CJwner of Wil;7n-..of receipt of frazardous materials covered by the manifest exce;V:Od in Ilam 183 <br /> Signature N <br /> PnnladlTypedName N10nlh Dav 1r.v 5 ccr, <br /> N - ` CD <br /> GENE <br /> SPA Form 8740 22(Rev.f2 17} Previous editions are obsolete BATOR'S INITIAL C--i <br /> I , , <br /> W0 <br />