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HewprintortM, FormAwo"d.0109 W.2OZ0039 <br /> UNIFORM NAWDOUS 1.Genomw ID Number 2.Page f of 3.EmeWfq Reep000e Plane 8.MMffW TMOJIV Nmmbw C <br /> WASTE MANIFEST C A R 0 0 0 2 66 a A 7 Z AI&aw 001785767 VES <br /> 6,GensraWo Nem*and Mal"Address 7R71C �AGY1�IrT Cenorator's Site Address Of ditr nt than rmeng address) <br /> 369 f0W WATWAT � <br /> CenDrralar's Ptrare• <br /> 6.T+ar Wter i Company Name U.S.FPA ID Number <br /> T.TmnspDrtsr 2 Canpany Name U.B.EPA ID Humber <br /> AT8MD=13A W M Id 0 1) 4 9 d 0 3 A 9 9 Il <br /> 8.Deslynated FGdity Nam*and Sb Addmas U.S.EPA ID Number <br /> z.t <br /> VBOEXAJ39 <br /> 1704 W.PM9T bE7�SP <br /> F Phow: AZE"CA*70 IC A D 0 0 8 3 0 2 9 0 3 <br /> i ga. Ob.U.S.DOTD*eprl m omWrV Proper$htppkrg Nam*,Hexad Clms,tD Number, A ConWimrs 11.Tocol 12 Unit t3.Waste Codes <br /> HM eW Pie�Qf&W)) No. Type 0uanttty )NW61. <br /> X 1'131T1134 WAFM MUM WNW 3,YLu <br /> � 1}117 331 <br /> 1 F ]0 F T1D4t <br /> X "XM WAM 3+AWT>IfJL►iM Ma'171IffAL BXXW Q =I3RI <br /> PAlK1 M I�Ya<l�q Nwwn ft <br /> COMMIUM%91 D+BQ 1 Ll lu! lid .P 171033 <br /> x 3. !t tI!y i. mot <br /> �54 KLVAM 36 u <br /> (oawbft <br /> 1 11C 112 v i?q� 13159 733 <br /> I t4.5peda[ttarrdNng n atfan 1#T4 C lD3 by�� + ropl{fr♦tt1 �4 " <br /> 1b 1[x3110!nlRtllWl fdtl M � - 1��T W�,71�Ali <br /> 1�Pi9�'. S)g�it1?A��)�8[i', I ��4 AA's <br /> 15. OlWtf MTOR'Bf WRORT Cl?RTtFlCMIMN:I*Dby dadwe dray die ooMKb oifh cone�mient era tu8y and aoarafely deeaibed abare by"props►aNpping now,am—*331w,packaged, <br /> marked oW lab"pterwded,and are In of respells In proper WNUM fm kamW aocordlrp b apOkable Intemadonal and nallonal gowmmentelex <br /> Exporter,t oartlty that the wrs6enta of thrs �uia&w.If PDrl ahl pment WWI am the Primary <br /> mnslgmrerr!Dordonn bo dre twrrrs d the atladred EPAAdcrwNisdgrtbnt of Cdlsenl <br /> i oadny thal 1ha waste mhr�mizedon stetsmant klerrdAad in 48 CFR 2822T(a)(if[am a large rtriarrdly generaiar}ar(b}�tl am a attaN querr8ly g*rreraforl F,true. <br /> GBnerelDr'"aro6 PrinMgA*d Name sgr,amro Day Year <br /> Q.+ V 1 <br /> f6.Inlerrrslforrai <br /> 11 Import to U.S. ❑F.m tram U,S. Prat of ermytaxtt <br /> Trabsporter stgnature(forogxwW only); oat*lea ft U.S.: <br /> of 17.Trenepor6erArdmpweddnteM at Raoelpt a MaleriBb <br /> ransporter 1 n ame 9iQneh... Mom Day Fe <br /> W It'�L#CCJIIEI tI[ d p � 1 <br /> a Tree muti Day/ay <br /> Year <br /> z/ <br /> t& <br /> 18a.D3sdgpenCyr Indkaihn Space ❑Qtlfy ❑Type ❑Resldrre ❑Fardel Relecdon ❑FuN Ra(et Yerr <br /> i <br /> 18b.Altemato Fndl4(or Generator) MMftf Refersrtc*Number <br /> U.S.ERAtD Number <br /> I <br /> Fadllty'a Phone: <br /> f&.80wtum of Faft-Ay(or <br /> Madb Day Year <br /> w19.Hazardow waste Report Management Method Cadee(r.e.,odes for hazeMouo waste Imatmeat,dlepaaal,and tecydirg sys6ems) <br /> 0 1• I 2 3. 4 <br /> 20.Deslpnaled Fad Xy 0mrer a 0pmffior:Cedfficadon d of hwodorm maforiala cohered by tire man oW etacepl m Idem 18e <br /> Prl ams <br /> Day Yaw <br /> EPA Form 8700-22(Roy.1 17 edMorlB are <br /> SIGNATED F I TO EPA's e-MANIFEST SYSTEM <br />