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� <br /> H A � <br /> fg +sR _� <br /> of <br /> J3 "Y � 3?g <br /> ergs r3Q Yg Z Arm <br /> d �V Td -•_ <br /> r s 3 s H N. 0039 <br /> g g a Mg No.2050 <br /> m .., s <br /> �^ 3 ararattmFbAn� :o <br /> o tnar no mateAar change has orcurred aUher In tht3 ahataoletietleS or In It1e Pro()4.MamHestT i Number <br /> C <br /> rrenrer io Number 2.Page 1 of 3.Emergency Response Phone <br /> OJJJ tt4onn�t �' <br /> A.rAt.nOOd220+l6 '!-2l1AR-r-- <br /> thaaddress) <br /> e�Manin9 Address Generator's Site Address(H digerent n maihn9 <br /> o g `` ��w Fabrication.Inc.�3I.E+ <br /> s a z styLinne RLIvAIAF <br /> 00// g53T7 <br /> v <br /> o- r r Company Name U.S.EPA ID Number <br /> Itte. I .-..� F!4 <br /> tai <br /> - 7.Transporter 2 Company Name U.S.E=PAID Number <br /> 8.Designated Facility Name and Site Address <br /> U.S.TEPA ID Number <br /> Safety to Rjs-ins. <br /> WJ pr;Y iJ O x 3 4£S 1 O 8 <br /> 37 E a�aG atattge ee Road <br /> 5 �irfieW.KY 40069 <br /> Facie sPhone: 2, -4 e--r <br /> ga. 9b.U.S.DOT Description(including 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 Wt.Nol. <br /> 0 1.P¢a��i-RrC:Y2Fi Fit��€1i� liS VdMM..L10U1fX13.(OIL VV/LESS Tr1AIN 223 <br /> a 104E WATER) 0 7 51 0 P <br /> w <br /> M 2. <br /> LU <br /> C� <br /> 3. <br /> 14;Spedal Handling Instructions and Additional Information 71SET# 41S+071 <br /> contract retalne-1 rhp cieftemor earls a ss agetk;l <br /> ifffhi{"e}(1 ItjJ{j7{{ ��[ pt Yri wirA fir Giri15{Nritss�lfltttnn�t Yf7nrr t'tnr-me rsan�nt-r"^ hah�I'fnr ym.+r.,n-.•........W.-......,... -.s., <br /> 15. GENERATOR'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 terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifl am a small quantity generator)is true. <br /> Generator'srOfferor's�}Printed/Typed Name Signature - Month Day Year <br /> 16.InternationalShipments <br /> ❑Import to U.S. ❑Export from U.S.u Port of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> { <br /> 17.TransponcrAcknowledgrnent of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> Nli.q Al Fin rInWrAl F7 X11` .cr _-.•.� .. Y <br /> Q Transporter2l`dntei/TypedtJame Signature `' Month Day Year <br /> � I - <br /> 1-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quant ty Type Residue Partial Rejection <br /> 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 /> 0 18c.Signature of Alternate Facili.ry(or Generator) Month Day Year <br /> d <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 2. 3. 4. <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintadyTyped Name Signature Month Day Year <br /> r' I <br /> TA Form 8700.22(Rev,12-0 Previous editions are obsolete. GENERATtOR'S INITIAL COPY <br /> CMAV Nva tta�ttre;iopr4�►ltat�pem is tar rrdH accept tha>t� a site q nerator is Oppktg. <br /> (41 70031 40NIA7-11(17 pPW <br />