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0039 <br /> g B 050 <br /> Kff �° o ?��. raoe7s aa_rerattn�gff"n1���0` ' <br /> o � _ o d N o_�gg°«mt no maiedai change has orcurred either th trio nhataolenette&Ot In the X 4.MamHest TraQkl"�9 Nimber <br /> Q 7{/'�� E <br /> o z m o �:/ rrerarer iD Number 2.Page 1 of 3.Emergency Response Phone o JJJh hVV a 1 v <br />,F N 14 <br /> O Z _ 9 f' <br /> o' n m r A t.()0 0 4 2 2 SY+! 6 if7r1l31 Afia-3718 <br /> v x 3 a dHfarnng Address Generator's Site Address(ff different than ailing address) <br /> address) <br /> o g Fabrication,Intl. ?I.E <br /> a z a�yjnrneRd <br /> � vfiiiYltr <br /> c <br /> 953TT <br /> o- �perter r Company Name U.S.E_PA ID Number <br /> tTe n <br /> - 7,Transporter 2 Company Name U.SN.E=PAIDA Number t4-w I <br /> a.Designated Facility Name and Site Address I Il <br /> U.S.TEPA ID Number <br /> 3700 E inaY"dtiEA R9cif1 <br /> 51"�t}tfteid."'40069 <br /> Facititys-Phone: 1. <br /> 9a <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste CodesHM and Packing Group(if any)) No. Type Quantity Wt.Noi. <br /> 0 1.h1a7WRICRA fitif`At•iO)OUS WAST,LIQUIr3S,(OIL W1 LESSTt1AN 2 <br /> Q10 U#.;ATFP1 001i r03;50 I'' <br /> tr <br /> w <br /> z 2. <br /> LU0 <br /> 3. <br /> i <br /> 14.Spedal Handling InsWctions and Additional Information <br /> NI=T# 4:ltsa . <br /> 1._E Er Wsiiet xl. 3.i it Vit <br /> �r�rritavE tet�lna+�h��enet�t+Jt vi3ni+�t5�i1�nu+ <br /> -iLdhDrrTe)ti Irth'iV tram,nrlor to A i nr ;iilrilfinnal fryncr "far-nn nanantrr' t+4ha1'rnr <br /> 15. GENERA70R'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged,V <br /> marked and tabeledrplacarded,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 terns of the attached EPAAcknowledgment of Consent. <br /> I certrly that the waste minimization statement identified in 40 CI--R 262.27(a)(if I am a large quantity generator)or(b)(ifl am a small quantity generator)is true. ti <br /> Generator'srOfferor'sP6ntL-d/Typed Name Signature - Month Day Year <br /> j 16.IntemationalShipmenfs - <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> - i <br /> 17.TransporterAcknovdedgrnent of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature / Month Day Year <br /> Fit 1 17.7 I �� - >' im <br /> Q Transporter2 Printed/Typed 17ame Signature /' ! t f, N Monti Day Year <br /> � I I <br /> l- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quant ElT e ❑Residue ❑Partial Rejection <br /> Quantity Type ) Full Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> < Facility's Phone: <br /> C3 18c.Signature ofAltemate Facility(or Generator) Nlonth Day Year <br /> d <br /> Z <br /> in 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1.LU <br /> 2. 3. 4. <br /> 20.Designated Facility Ov✓ner or Operator:Cert cation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printe&TYped Name I Signature Month Day_ Year <br /> J. <br /> TA Form 8700.22 Rev,92-17) Previous editions are obsolete. --� <br /> rr <br /> cfe Ha nae the"Woprtate mm"ux and Mo#accePt IN wait$the generator is jhIpphg GENE WS INITIAL-c- Py <br /> r i 71?n Ailtl 7--M7 ppw <br /> ION <br />