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Please print or type.{Form[� fs fed for use on elite(12-pitch)typewdter.r-' Form Approved.OMB No.2050.0039 11N1Ff]TE HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Respo hone 4.Manifest Tracking Number WASTE MANIFEST C: r1. f, R; ;I ? T00 112.E-r; 61016662342 JJ K 5.Generators Name and Mating Address �iii IJIN I ON F ai(-0�±-i i 0E•I#,Ir. Generators Site Address(ff different than mailing address) ,r( I hc7[:AI°Vlr14 if'� "Dt-D C'Oi:41$f4!0Fj F REICHT UNG. #FIf_',4]A:ata"t_L 20 i E j:'',e!,L.10-.1 Aih-- Generators Phone: V f; (v i1 r_; '' _ [i y ,¢ *kHE-40 P2001 6,Transporter 1 Company Name '1aH(;t E(Zvi ollrrl,.�,t,_i .�,,. U.S.EPA ID Number 7.Transporter 2 Company-Name U.S.EPA ID Number 2 8.,Pes[groted Facility Name and Site Address t_,rCjF;t r,&r.Verton U.S.EPA ID Number ref da Q I FadlilysPhone-."2 432-544) A I-', ga, 9b.U.S.DOT Description{including PrflperShipping Name,Hazard Unit Class,ID Number, to.Containers 11.Total 12. HM and Paddng Group[f any)) No. Type Quantity 1 (Unit 13.Waste Codes a (11orh RC A IgLazardous�L,te,i�rr-,}i(..a#��'a.i.': luI X F' LLI IV 0 Ire/ Pr 3, THE REFERENCED«'ATIM.WAS RPM-1 IM.HAKI)LED AMU SYOF M FOR SUBSE 1 PN r()I TSrrr, 1)1SPOSAL.TREA-17.CL•ti t'OR n'i_:i•11 CP.)."IL h nVl 1.N'tNC O 1]i2MZ 11111 1' t1LrIY t'rf v. PFR14rrS GRAA'ti,:fj TID-11W.14-:tit-T:Y Ti ti's i e�'ARTtS--ti'C O• FO:IC 3t.:6TA"iCE['7R'r .6t..To(;;[!i-r 4. - .r ,. .1 C-TTr.1 THE RESOURCE'CgNSf-:LVATW'.-J AND li7:CY7VEXY A[1'01; 1474',QGCi}IE;: t'.-;IF AM.rr Ani) 17EDUAL AND STATE JLLGW-A'Iiu VS CROSBY A f V15-VI IN I AS AL1- C;1i Ta' MFC1i'S.ti.• PFRAM TO AC(F,PT'j1tL,w-;LRFNWASTE AND ALL Tjo, 1YAs'M IiAS j fEN HA 11•j ACCOiWINGLY LF 14.Special Handling Instructions and AddilEonal Infom,ation +Y lqf f I-5-;5,7pi� 1�'- Iz � i��•��--}�.� 7`71. Afur�?vr 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and a=mtely described above by The proper shipping name,and are classified,packaged, marked and labelediplacarded,and are in all respects in proper condition for transport according to appllcabte Wemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform,to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.2T(a)(ff t am a large quantity generator)qr(b)(ifI am a small quantity generator)is true. GaneratorSUIOu e " P•tedffyped Name� � Signal re Month Day Year --- , 0 1 16,Intematidnal Shipments Import to U.S. ❑Export from U.S: rt of el�lry4lexit Transporter signature(for exports only): Date leaving U.S.: LU i7.TrensporterAckrwwledgrnent of Receipt of Materials Transporter 1 Prinledl yped Name r S gnature _ Month Day Year dTransporter 2 Pdriledffyped Name Signature a Month Day Year Fr 18.Discrepancy 18a.Discrepancy indication Space ❑ Quantity []Type ❑Residue ❑Partial Rejection ❑Fuil Rejection Manifest Reference Number. 18b.Alternate Facil ty(or Generator) U.S.EPA ID Number U ri Facility's Phone: ow 1Ec.Signature of Alternate Facility(or Generator) Month Day Year a 2 y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Treatment,disposal,and recycling systems) 1' f 2 3. q 20.Designated[' ity Owner or Operator.Certificalion of pl of hahrdDus materials covered by the manifest except as noted in item 18a Prinledrfyped me Signature Month Day Year EPA Form 8 0- Z(R .3 05) re Io s editiorls ar6obsolete, - DESIGNATED FACILITY TO GEkRATDR