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Please annl or lyprr <br /> Form Aliprovi!3,OMB No 2050-003.9 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2 page 1 3 Emergency Response Phone4.Manifest Tracking Number <br /> uu <br /> WASTE MANIFEST :1 1 a317�d94 JQJ4 58493 FL <br /> • a^n . mss man r,-m lno address; <br /> O'a,%,UNS BR,)CKvW'r" 3iA-5 uN tAj1`1HR <br /> 14700 (--HULrE- <br /> �t_'f>�, <br /> RAC"' CA 46J715 <br /> ",airipm%PHune. c s+ <br /> Traricporfer t Company Hamv 15 EPA b7 Nuriit s r <br /> E'11R)f,JFAEiV"A.l -?' SUl.T!i`!" ''Ir_ - �16 R 0 D ii 2 <br /> 7.Transporter 2 Company Name us:PA 0 Narn6er <br /> g,i4ysirtn iltJ Fiu�ty Nawr argil Sits Ari fi-,V US EPA ID Number <br /> Caiit,rria -all Trap4er <br /> ,;304 c4is Rif <br /> Rive:tarok 1r' 4539 i <br /> Phe�e -, .�..•)-51 1 I - i, I_ •3 9 13 ) i5 <br /> ga 9b U.S DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number. 10 Containers 11 Total 12 Unit 13 Waste Codes <br /> HM and Packing Group(if any)) No Type Quantity WI Not <br /> 11'100 1»CPA HACAR1) il`= 'f4S F Ll';,U!C) <br /> a - _ - - <br /> TT <br /> Z 2 <br /> w <br /> 0 <br /> 3 <br /> 4 <br /> 1.1 S �d1F•47nWingln511u1:1xHi5an,lArtrlili<r^h}Informa6on `J#q5�99 01L, ' ,+TER FRC* j 11913-171.,-,C•T ERG*154 <br /> EPr=#1501 ER„#154 01L_Ei-,C, F, ;_r F±i=x �2aq, --RESTUi`k <br /> Oi)r 717 <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of[his consignment are fully and accurately described above by the proper shipping name,and are classified,paCKaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262 27(a)(if I am a large quanlityg9 mraW)or(6)(ifI am a lily generator)is true <br /> la+'s'Olfa(4rs�,k"f pmt L� r �'r.+'kirr e� -'env <br /> � rks,rth Dai 'v:c• <br /> ( {�J l ! CJ'!' <br /> J 16 i4inationalShipmritsir <br /> ❑Import to U S ❑Export from U S Port of entry/exit. <br /> ? Transporter signature(for e)cpoits unlv): Dale leorving U S <br /> 17.T nes o_rler 2"W merit of Receipt a1 Mial-w S <br /> TrarypgrlprLWntedlTypcd N <br /> r d .�.rri r �i fr /girt- a G Z <br /> z Transpo iN 2 PrWedfryped Name — Sign Month Day <br /> Qd <br /> 16 Discrepancy <br /> 16a,Discrepancy Indication Space ElQuantitylJ r.r.: _ Residue Partial Rejection El <br /> V111116-0 qq*%c re NumCer <br /> C tetr A1lamtiw Facility(orGerreralar) <br /> is EPA ID Number <br /> J_ <br /> V <br /> wf,;y,Phone: 0" ifl <br /> F8c SfgnakaC uiAlternate Faplity(or Generator) hAonth Year <br /> W <br /> I <br /> 19 Hazardous Waste pori Managuknent Method Codes(i e,codes for hazardous waste treatment.disposal,and rerycting systetris) <br /> 20.Dbngn+rGd Facility Owner or Operator. :c•tlf r cc,n roc•=:,'of i,n. materials covered by the manifest except as noted in ' •16a <br /> o <br /> PnnledlTypertriararr r..i�t;tr,•� ff lk,nm E,y �,r <br /> Ll <br /> EPA Form 87M-72(Rev.12-17) Pfevous.editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />