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661- oho bH1P# E31.:4b:56 00 a 305741SK5 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.l me�_rgenvy Response Phone 016M �`t Q�(WASTE MANIFEST f uu,24bt3—I It,0 i�•l f■ SKS 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) ul Ke11 i y # ,58110 ibt!i w main St IN 11-1 LIN CA 9536b—a01 K� Generators Phone: CKr-�—b9J 1�)4t 6.Tin r 1.Company Name__ U.S.EPA ID Number b!iPL I Y-1tLti=r+l bY�i t MS Irk; t;tFLkd008161Cvz� T.Transporter 2 Company Name U.S.EPA ID Number LL EH N I1-14 iBOkS ENV SVL: !Nt',.. Pli ii►19��.i��f0 8.Designated Fadlity Name and Site Address L:LEAN HHR81iJkS LtiNASSY M OLIN FAI N U.S.EPA 10 Number 3 PliLES EAS-1, 'I MILLS NURIH KNULLb EXI-k 41, 13FF 1--60 t�NflLLS , i�i fi�4{8ti3 4 �'�E3El4- 1 tJi1.991-�W11411 Faeili a Phone: go- 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Paddrrg Group(d any)) No. Type Ouantity WI.Nol. 1• iVLIN—kUHA HALAIRO JS WHS#6, SULib, �QI LIM 100 N 1dI O l�iEi.`URBENI HND U1L), WAt,�— W L7 3. 4. 14.Spedal Handling Instructions and Additional Information f bU:8M By 1 bb6-41 ON 1-8'C.'54 ta86 ;;I-taggo-7q4 , e4H E14LRGL LY#E300-468-17bW—L:ri/SK/ IFI-Lontract retained by generator confers agency authorit on initial transporter to add or substitute aijg3.t3,onai traj)Sporcerr- r rl 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, marked and labeledlplacarded,and are in all respects in proper condition for bansporl according to applicable international 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement Identlfled in 40 CFR 262.27Ia)(if i am a large quantity generator)or(b)(if I am j small quantity generator)is Irue. Generator'sl erors Printed/Ty are Signature Year e�r�c - I Svia _j 116.Internatonal Shiprrients F- ❑Import to U.S. ❑Export from U.S. Port of er"lexit M Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Adurowredg neat of Receipt of Materials Transporter 1 PrinkdfTyped Name Signature klonth Da Year IL Transporter 2 PdnteCyped IN Signature Month Day Year I 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ruantl ❑Full Rejection ty ❑Type ❑Residue Partial Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V w Fadliys Phone: 18c.Signature of Alternate Facility for Generatof) Mwth Day Year 4 Z 19.Hazardous Waste Re rt Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) LU 0 1 � � 2. 3. 4, 20.Dealgnated Facility Ow er or perator.Cordlkation-3NMipt of hazardous materials covered by the manifest except as ed n Item 18a PrintedfTyped Name Signature Month Day Year EPAFpTrr187QO7,2{R v �2-�7].Prjviaus tions areob—mike. pESI ATEA FACILITY TO EPA's e-MANIFEST SYSTEM i ; 1&Zl l/ t45a 1t3�