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Tr = IIIpIIiIIIiII�I�NIUIIINIalllll <br /> 0073134373 KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number �,.� - 2.P g 3 jERes➢o}45e Rholts... 4.Manifest Tracking Number <br /> UNIFORM HAZARDOU <br /> WASTE MANIFEST �} nJ 1007313437 <br /> 0 7 3 q1 3 /� 3 7 SKS <br /> 5.Generators Name and Mailiry Adtlreas Generator's Site Address(if different than mailing address) <br /> � n _ <br /> Generators Phone: <br /> fi.Tmryspwfer],CompanXtramp „1 U.S.EPA ID Number <br /> rplf <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address f:j- r.r. =: r U.S.EPA ID Number <br /> Facility's Phone: <br /> ga 96.U.S.DOT Descdpaon(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> Ar - ,-nl_.nrc� �7 ��r`Ilc _h�:r,-r •-.nt * � r..y,. 'y1 _ _ <br /> K <br /> W <br /> Z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14 Special Handling Instructions and Additional Information <br /> r <br /> �KD LA l� <br /> T,u <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 am classified,packaged, <br /> marked and Iabeledlplacmi and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the aaached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization tatement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(iffir a small quantity generator)is true. <br /> Aerator erors Printed[Typed Na ignaturo Month Day Year <br /> J1f.Intematianal Shipments <br /> p_ ❑Impmr tc U.S. ❑Export .5. Port ent <br /> M Transporter signature(for exports only): Date leaving U.S.'. <br /> W 17.TraniAcknmvledgment of Receipt of Materials <br /> Tran porter 1 Printedrryped Name Sign Month Year <br /> a t <br /> z er 2 Pri Asa Name Si Month Day Year <br /> Ih 1 1 <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> ty, Type Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone' <br /> our 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazard us materials covered by the manifest excep noted in It <br /> PrimedRyped ame SignaWro Mont D <br /> i <br /> EPA Eoun.fl70422(tev ?2,SZ);Pseviouseditionsare ete. D GNAT ACILI TO EPA's e- ANIFESTS TEM <br />