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NIaaSB <br />flrllnr t <br />D. <br />''+""""" """"'"' "Vvv """" <br />UNIFORM HAZARDOUS <br />1, Generator IONumber <br />'rr-' <br />2. Pogo 1 of 3. Emergency Response Phone <br />7 �nt� <br />A, ManifeslTracking Number <br />FL <br />012218721 <br />WASTE MANIFEST <br />,1 t,rnr (' <br />r;,r..t <br />i <br />0 Genoralor's Nemo and Mailing Address fonoralora SdaAdNoss dddforerd <br />q>an fnalT47g �drass� <br />r, <br />f,otllfi MvIlir al r. t, l�I Apt I,.. !<tr r � fAl�lli�:�i 1'L�;t.l �:u!Ir�t r,r uid (�r d{�:,! <br />.r<<,li ,r , t . <br />if <br />o rnr, �s�) 13fS1111Pf Lt1 sj(]r t1l }I�lilir�r I 1 1} <br />I . r1, :�' r ,, f A Dr)700f <br />t ,ll, GA C#"IN <br />GoneraloesPhono: a�L-?L�1�1D^� <br />6 Tran,poler 1 Comparry Nmte <br />U.S, EPA ID Number <br />�,;I�c. l �tlltlil�ilt`,'z1t.0"Y;�')'i <br />ir' ti <br />l�IluilniClltdl <br />7.7S TZ <br />U.S. EPAIDNumber <br />0. Designated Facility NemoSlle Address <br />U.S, EPA ID Number <br />pa�nd <br />f I7i rc0LnrY NEVADA <br />wP r r•r�n <br />I , ,�r, 'I'I Mlles Bath t,f Bu4titt;o <br />: II <br />tip <br />4 <br />Faolcifi s Phone: 77G .,, w.t <br />ga, <br />gb, U,S, DOT Dosalption encluding Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11, TOW <br />12. Unit <br />13 Waste Codes <br />No, <br />HM <br />and Packing Group (t any)) <br />Quantity <br />WINoI, <br />1, <br />hwi-tioRCRA, �ieaarduu:: VVAL11r, t iquid jSu.faua;�,lli�j <br />r1bFF <br />q r•. <br />o <br />r <br />too <br />W <br />2'`1.,h.PrRA Iiazatdous Vtira ,tc, Lt-juld (Dusgutall) <br />P <br />(IF <br />11W,264, Waste Collo%tkot liquid, ac'i-lic, inurgath, mu,:;. <br />I <br />I1�G2 <br />MYLIROGHLORIG AG10 601+0RIG ACID), 0 , PGII <br />Dr <br />i <br />1 <br />4.t1•;i1-RCRA I'lazdadous ii afrtv., Liquid (3-5% Hydiogen <br />c <br />Ne1erxid) <br />rJr <br />r <br />14. Special Handling Instructions and Additional Information C•Clb'11'c'!'(i: <br />.OXlr <br />f j 0704131G►0-3iw921B�I^l�a� 3) 07x'`r1:3770F...,3T.5 L-P1:015!i <br />I)C05' <br />'r.. !?%t11' 4 570o31'sx'2 i 4} 070 1.+1'i7l? 'ii a2 ( <br />10, GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the annlenis of Uls conslgnmont are fully and accuratelydescdbed above by the propo shipping name, and are dass'ded, padrmled, <br />marked and labefedfplacarded, and oro In all respeds lnpmper condition for transport accoi to appl cable intornationaland nallonal govemmontal <br />regulations. Il export shipment and I am the Primary <br />Expotof, I certify %ai tie contents of Ude emOgrvnent oadorm b Oe tars of Na altachod EPAAcknwMedgment of Consent, <br />I certify that the waste mfnInha6on statement Identified in 40 CFR 26227(a) (if I am a largo quanOty generator) or(b) (III em a small quantity generator) is true. <br />Go raloesprOBe a�PinI Nave Signature <br />Moog Daayy You <br />�°® <br />!®/ Div <br />d 61 (9 <br />c7 <br />w Pit <br />10. int madonal Shipments <br />❑ Impod to U,S. 0 Export from U,S, Pod of oniryfexih <br />Transporter signalure (for exports only): Data leaving UIS,: <br />W <br />17, TransporlorAdaewledgment of Reo* of Materials <br />Trans tedfT o Signature <br />Month Day Yew <br />a <br />L <br />` <br />`7 <br />Of <br />T Io2 na <br />4 reel MtE I <br />MOAN Day <br />10. Disuapanuy <br />t0a.0acro I wt an Spam ❑ Quanlity El Type ❑R siduer v <br />❑Partial Rejection <br />❑FullRoje6on <br />lAan11091 Reforanco Numbol: <br />106.ARematoFacility (or Generator) <br />U.S. EPA ID Number <br />v <br />V <br />LL <br />Faaws Phone: <br />Ilk S'rgnaturoolNlemaleFaa6ty(arGenemtor) <br />Mon% Day Year <br />cn <br />19. tfazardous Waste Repot Management Method Codas(Le., codes for hazardous waste Irealmonl, disposal, and recycling systems) <br />® <br />i• <br />2 <br />3. <br />A, <br />� Designated Fac7fly Unser olrooetpi of lariats by %e manifest exwpl as kis Item tOs <br />PrambdlTypmd Nana Signature <br />Da ear <br />Y <br />/- <br />/ <br />EPAfams700.2z(Rev. 12.17) Pravioused Nznsnreobsoleie. UF.SIGNA1'[:01'ACILI'Il''I'O <br />(,PA's <br />u MANIFEST SY i <br />