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Pfeaseprint.oc pe. Form A proved.OMB No.2050-0039
<br /> UNIFORM HAZARp0�S. Generator 1D Number 2 Pale 1"of .3.Eme en Response Phone 4.Manifest Traeidn u
<br /> `WASTE MANIFEST
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<br /> 15 kGENERNYOR'SIOFF RCR'S Cffi11F1C147tpN:i ha declare 1M the co i6erris of tltfs
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<br /> nmrked and labeledlpiacagded,agd stein a!I respeGs Irl proper eonditlonior transport according to apPifcable Intematlonaland national govemmenlal regufatioris:;if ezpott.sh ""ant and I am the Pri
<br /> ::::Exparte,'7, ilifylhat the etatienls of this conegiiment.eonform to therms of the allaghgd EFAAchnawledgment ' '•_,.:
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<br /> 18c.Signature%l ltemate Fadtlty(or penerator) Month '.Da" Year:;
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<br /> 19.Hazardous Waste Repor!Ma nagemeirt Method Cedes:Q.e.,codes for hazardouswaste treabnent,:dtsoral,and reeyding systems)
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<br /> 0 tY Cpeia6or • 7gtlon'gf rete t of hezaidaus matedafs wvered the mandest exce" as nded Item 18a
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<br /> PAFam 87 "22(Rev.1247)Previous ecrl ions: a obs,oW, DES :.` `7`ED FACILITY TQ EPA's.e-MANIF. .`7 SYSTEM`
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