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h <br />tease <br />print or type. (Form designed tar use on a8in {12-p1tch) typevmhsr.) <br />rwrrr+y {��Y�. vmv rw. avdvvvaa <br />UNIFORM HAZARDOUS 1. GeneratorfD Nial:ber 2. Pays t of 3. Ema�goncyRasparo Firona <br />4. Alantfeet7racking HumMr <br />0 0 7 0 9 7 0 3 FSE <br />WASTE MANIFEST , <br />5. Ganerau>fs tlarrre a McBtrgAdd s Gcineretces 51t Address (d 6remA than magna addrrrss) <br />RIMS -M:M�M?XN 1511 <br />OEM <br />l <br />Ge ZP <br />a e. <br />D. m a <br />c � � � � <br />U.S. EPA W Nambor <br />�= <br />7. Transporter 2Clsr:pa:ry Name <br />US,EPAIDNumber <br />0,DDaaUraWF NamaondSlraAG <br />U.S.EPAIDNunbe <br />G, <br />�t 9 <br />9- <br />FadlWaPhooe: <br />9a. g.US-DOT Da=�&n ¢nduding Proper Stdppftg Her", Hazard Gass, tD Nurnw, 10. Containers <br />1L Totai 12 Frit <br />1J. Wesl9 Codes <br />HM and Pa'd4JnppG�mupp,(d�a ry�))J Na Type <br />Ouant?ty WuVolt <br />n <br />t <br />4. <br />14 Spadat h4ndGng lr andAdd clonal In arraCen <br />15. GENERATOR'810FFF.ROR'S CERTIFICATION: 1 hereby dedere Wt tha contents of this cons+gnovlt aro fray and amrrala:ydosaibed above by the prcpor aH ng name, <br />and are daswed, padaged, <br />mated and trbe?ab'p umded, and am fn all mspods to pmper cargh6oa for transport acanrrg to opp9cobfo bnterwranal and nat brmI gvremmentai reguh&xts.If erAon <br />strip renlarxl tam the Prlmary <br />Ergrcrtot, I cer* that the contents of this consignmont mnform to the terms of the attached EPAAdaro lodgmonl of Cammnt <br />i that the waste m>rdmlzedon stalement Idanlifled h 4D CFR 282.27(a) {d I am a large quarditygcrardler (b) tem a genrxztar) Is true* <br />erota saura <br />month Day yeu <br />W A <br />f ElIq /5" <br />—t <br />t~ <br />t , Doan % n•.ents OT <br />❑ Imped to U.S. Espen Pof enhom U.S. " tryte dt <br />2 <br />Trdns=far4lqmburq jfurGnIft Oona I U.S.. <br />17,Tmmp WArirnoWAdgmanlofRecelptofMateniais <br />Tra S Prx WdlTyped No fu <br />aY ea� <br />QL <br />�"f /GL1� <br />Z <br />T=poder2 PdntedfTyped Nams �nawra <br />ane� <br />18. Dfscapanc/ <br />Wei DlsrwapancyMtcasonSpace Quantity E] Type DRasidua <br />C --t <br />L PartialR*riur+ <br />FulRop3dfon <br />Manu Ruferart a Ntmter <br />18b. Anemate Faclk (or Generator) <br />U.S. EPAIO NurnJW <br />v <br />914 <br />Fact, sPhone: <br />- <br />1Ec. Signature otA:temata Fac6dy (ar Gonarz�r) <br />Grande Day Year <br />a <br />Z <br />N14, <br />Hazardous Waste Ropod Mansproanl Herbed Codes Q.o., codes for hsuardous waste baatrmt, disposal, and rwj6 g systems) <br />0 <br />1 <br />2, <br />g <br />4. <br />2D. f)estgnatad Fadfay Oxnec a Operator Cectifraticn at rocokl of s materials coverod by the manifest escapt orad h ifarn 18a <br />PnrstedtTypedNmna Sigrahrm <br />� I�x�Ysar <br />yay <br />EPA Farm 8700-22 (Rev 3.05) Pmvicus efforts are obsolete. DESI.sNATED <br />FAC•:LiTYi.0 DESTINATION <br />SL AT i, (IF fZF-0 )IRc:C9 <br />