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M CD = moo <br /> CD Ojv <br /> v CD O rJ <br /> -n ' < �* � CD <br /> O C A CD CD <br /> � O <br /> O n J <br /> WASTE MANIFEST CRL 01104379A, <br /> Q <br /> �-I 5_cien�yrNs Name and Mailing Addy 3 <br /> M D011ar, Trac #N/G48 ,,.. r -V -.. 3 PO <br /> = fc479t gi-: —F] 2 31E W. Ie3an Sr. :."'11ar Tr�a CD j <br /> Generators Phone: u, ia07CD <br /> 6r® <br /> e.Transporter Company ame W <br /> t-r- v _]e &neGi alt a ste c•rl,�then= Inc <br /> 7.TranspoM ., <br /> Oil <br /> 8.oeslgnated Faamyrlameane SaeAddms 2lst Cent ut-v EMN. LLC u.s.tt A lO Nunoft <br /> 2095 Newlands Dc. East <br /> Fer-nlev. N) 99408 <br /> Faaliys Phone:'7'75575P760 NVP9@$E?5??e �J <br /> ya, <br /> et,U.S.DDT Dasc iption(nduding Proper Shipping Name,Harald Class.ID Number, 10.Containers 11.Tural 12 Una 1S.Wa h Cees -6 <br /> HM and Padorg Group(aany)l No, Type Ousntrty NgNd. O <br /> Y JIUN1950. Waste Aerosols. flammable 2.1. ERG#126 1 LF 00083 A 331 [3001 7 <br /> o s C7 <br /> D <br /> W Q <br /> W <br /> � F <br /> 3. <br /> I <br /> it <br /> 4. <br /> 14.Specht Handling Instructions acrd Additiwlat lnformation 1. 100843(Aerosols) OF <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I herebydeclare that the contents of this consignment are full and accurate) described above b the r shipping name,and are dase;6ed �x- <br /> 9 Y Y Y P� PP 9 <br /> marked and labeledlplacanied,and are in all respects in proper condition for transport according to applicable intemational and national govemmenlal regulations.If expod shipm nil and I am the Panay <br /> Exporter,I certify that the contents of this consignment conform to the teens of the attached EPA Acknowledgment of consent_ <br /> I cerff the waste mimmaation statemer41den-ed in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a smqtr lit, en to <br /> G e ion' PdnE yped me i na 1 ear <br /> C 0� !3 01 <br /> J 16 ntemational S'pmenls <br /> F ❑import to U.S. ❑Export ho U.S. Porto xll: <br /> Z 7 <br /> nsiporlersi nature for exports ona1 Oavin S.: <br /> 17.Transporter Acknowledgment of Receipt of Mafedals + <br /> Transporter 1 PnrW fyped Name na r to Day Yea <br /> a <br /> Anthony Mack Jc i9 =01 <br /> Qi Transporler2 Printed(Typed Name Signatureyew <br /> F Mph <br /> i, <br /> 18.Disaepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejec4m <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Q } <br /> �- Fdelll'S PheM1e: <br /> W 1 Sc.Signature of.remote Facility(or Generalorj ^lh co'/ <br /> H <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recycling systems) n 'U <br /> Q t, 2. 3.--Tj q <br /> 1. O <br /> DQ <br /> 20,Designated Facility Owner or Operator Cerlificallon of receipt of hazardous materials covered by the manilest except as noted in Item 113a <br /> PrinladlTy ame , �� Signature Month = <br /> v � <br /> Liu <br /> N <br /> EPA Form 8700-22(Rev.3-65)Previous editions are obsolete. DESIGNATED FACILITY TO CD <br /> DESTINATION STATE 1IF REOUR 01 <br /> :371�17J—'r7" 1;✓v.� f G1 ti/�-7far'hi Rrr,: ,n+rr n (p CID <br /> CD 00 <br /> -r� 4:�, <br /> O <br /> O <br /> IV <br />