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1 <br /> IIIII1111IIIIIIII�IIIIIII IIIIIII �o���a9 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator 1D Number 2.Page t of 3.Emergency Response Phone 4.Manifest Tracking Number c <br /> WASTE MANIFEST 1002010366 VES <br /> 5.Generator's Name and Malling Address Generator's Site Address(if different than mailing address) <br /> MB EX GROUND 9M6 <br /> 505 flOOD WAT <br /> en�j PF MTN X17 <br /> 67 <br /> 6.Transporter 1 Company Naffs was U.S.EPA ID Number <br /> VEMLA B11 TOCHNW.4L 90=0m 14 t 1 (; a 0 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number u <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> ifBOUA ER THCffKW-4L SOLVIT= <br /> 7&5 SAY 79 <br /> BEAURWINT,TX Tr <br /> Facility's Phone: 40 73&2.62.1 T x D 0 d 0 B 3 9 g 4 6 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> a0 N i - HAZARD=We�E LIQ={ATS Fes■ 331 <br /> 0 <br /> M 2. <br /> uu <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information M 4 W by VEM `)' Cw*wt <br /> OT 9 OE �� t7i Ebel @!I�d 1 <br /> + I)W <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in A respects in proper condition for transport according to applicable international and national governmental regulations.It export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(ifi am a small quantity generator)is true. 01 <br /> Gen PrintedfTyped ms SignaturezLlt Month Day Year <br /> x 101)-sw <br /> _j 1 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only)- Date leaving U.S.: <br /> w 17.Transporter Acknowledgment ofRecelptofMaterials <br /> Transporter 1 Printedlryped Name Month Day Year <br /> aTransporter 2 PrintedlTy Signature IA Year <br /> M220QZ I <br /> 18.Discrepancy <br /> i8a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> C7 <br /> Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) -T <br /> onth Day Year <br /> a <br /> Z <br /> U) 19.Hazar ous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifes xcept as ncted in Its a <br /> Pri S' ur Month Da Year <br /> EPA Form 8700.22(Rev.1 - ) Previous editions are obs fete. QhSIG ATED FACILITY TO EPA's a-MANIFEST SYSTEM <br />