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Sit SHIP# 2164-6614-1.4-- <br /> PI print or type(Form designed for use on elfte ...... Form Appiroved.NiNO.264469. <br /> UNIFORM HAZARDOUS: Number i 2.pop 1 Of 1 3.ErRergeng.!�j rise Phone C.ManIfest Tracking Number • <br /> WASTE MANIFEST,, r Xc <br /> 10 0 484 2-Se 2L 8 KS <br /> B.;GihiratotaNathe'aridMalihiAddmss Generators Site Address(If different than mailing address)- <br /> lair, hl9tly Dy, <br /> f-AVIOWD01 I: <br /> '6.Trggite C ,?N U.S.FPA ID Ntmtw <br /> 7.Transporter 2 Company Name U.S.EPAID Number <br /> U.S.EPA ID Number <br /> I-, -14A RRURS fiAWADW L.LC <br /> Y) 1*' 133 <br /> Facilty's phorte:.. <br /> 6.U.S. <br /> .DOT <br /> ­;...- .. Oi6lperblhippirgwa Hazar, 0* bar,, <br /> ga, 9.U.S.DOT-Descriptlon(Indialrig dClass,1. N-u-m- 10.Corigirifiri 11.TOW It Until <br /> HIM and Packing Group(IFany)) l . Quantity. <br /> WL 13.Wase Codes. <br /> NQNE' NOM- RCRA <br /> 0 MM1119ENT'S chwhimiWiTED W1TH:,,C11L)-,-: N?A A <br /> w <br /> 7r <br /> 0 <br /> ,p <br /> 4. <br /> V A. <br /> 1!-Bpeql Hgridliflill Instructions andAddlitional 177:; <br /> p...it <br /> t'Mosewly'41 <br /> t3K ALM <br /> E 40RIZED TOM-_'rA1hl '1.'Tr_rt'N8V'D' 1!1J_)RGrf5l.lrNT f4p <br /> I& GENERATOR'SlOFFEROR'S CERTIFICATION:Thereby <br /> that the contents of this consignment are fully and accurately described above by pr9per shipping name,and are classified,packaged, <br /> in 6,,res eels. . :., - . .., . .... <br /> marked d labeled/placandlid,end are in proper condition for transport According to applicable International and national 66,varnmen'tal qui,t , f * sh1pmentIE;I;2ItMIhePrImwy <br /> an <br /> 'art a ons.,I ex*. <br /> Expcq1ilr-I iffy that the confents of this consignment conform to thelarms of the attached EPAAcknayilail <br /> gTent of Consent. <br /> I cerW that the waste minimizallon statement Identifie <br /> ,4in 40 CFR 262.27(a)(If I am a large quantity generator)or(by 61`1 am a'snIall quantity generator)is true. <br /> GonerstorWeZoiMn me <br /> Signature 'McArth -1 Fay Year <br /> A <br /> b'16.Intfirrieffortal'ShIpmeh <br /> e Import to U.S, Ll 51. U.S. P6do entrylo)dt: <br /> Transporter sIgnature(fof exports only): Date leaving U.S.: <br /> VJ*sporler Acknowledgment of Repelpt of Materials <br /> Transporter JjP i tedfryped Name <br /> 7 Month' DayYear <br /> IMP <br /> MM Day Year <br /> W Dlscr <br /> .18a.Dlacdepancy Indication Sp aw, E]Residue 0 Fuli Rejection <br /> arU@l Rejection <br /> Manifest Reference Number: <br /> t""qle fscli�(0! :77.1_, U.S.EPA.I.D.Number <br /> C. <br /> Facllll�s Pfiohei ;P 4, <br /> 18c.61ghakirdofAiternalefa*dlV(orGenemVo-' X_J'I. <br /> Month.­ Dayv. Year <br /> 7, <br /> L <br /> ethod Coda PA,codes for ouawastakeelliment,disposal,IfridpayclIng SO <br /> ig.Hazardous Waste Report Management M <br /> Ao <br /> r0 0.*g"s ad Fix Owner or Opwal CwMcdm of mcallpt of hazardous melferwe collared by be maufftst axwo <br /> P,11.dMpAdI N._ Mon I th! Dag -Yw <br /> EP�F,071, R editions are obsolete. GENERATOR'S IN COPY <br />