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00798637 7 55 K5 <br /> Please print or type. Form Approval OMB Na.205NO39 <br /> UNIFORM HAZARDOUS 1 Genemra 1p Numlaa CpLPvTN�5'ettu 2vaggld 31Emnpegy Reypuegpx, d.NanlMlisaoteq NunEn <br /> WASTE MANIFEST oUM69375 SKS <br /> 5.Genera Name and Melling Address Gmerelde S&PaNeu(Il different Man winds real <br /> In'QI' <br /> E five!?'1OM Name US EPAIO Number TV-Y,I_r_N SVc,��.:. TXR0490081 HC.::. <br /> 7.nanapoRez 2 Camper,New U.S.EPAIONumber <br /> , _ d'Pa HARBORS ENV S._ -1 -. MAD03932?2i50 <br /> e Oedw1ed F.dM N.a1098eMhees CLEANH,,RLDR5 Of BUTTONIdf LI rjW US EPA ID sudden <br /> 2500 LOKERN III <br /> RUTTONW.ILLOW , t,0 33c.0b <br /> E6:-?6�62F0 CAD900o75276 <br /> FaGI a%nn'. <br /> 1 9, US DOT IMsoepdn(houses ProDa Sbpprp Now Eazrd New,ID Numbs. 10.Coma'rws 11.Trial 12Uti1 13 Wpb CMae <br /> NAI eb MGup(naryl) No_ iytt coil" wUvdi. <br /> 1- NON R: rYA H^2RRpOUS WASTE, SOLID, DN <br /> M �QV r 181 <br /> (ABS PBENT AND OILI , RN <br /> do <br /> i 2 <br /> W <br /> d•J <br /> a <br /> d <br /> I <br /> 1a spaPd wMe9 msmrmpr®we<mmlN mlpn,eml TSD-.BL 86252902 OR16176 <br /> f"UVkCtaO-468-17EP.-Cri;Fr:;TF?-Lu nt•-act .zr,a,ned by S,_ <br /> to <br /> 15. GENERATOR'SAMPTRORSCERTIFICATgN: IFereby Oedare Mal lrreamlmb dMis mnsgnmenl are fuM aM eroiradydevabd abme by Me proper seipprg name,Maredeefied,paeal <br /> marled and Mbelediplaranded.and areM all reslrea6 In piper Pal for trdnapad according 1oapplrede morralbral and natlanal governmental ragda6ons llev[M't aNDnlenreM em 11b Prvnery <br /> Ermd,man <br /> Nal mid.... <br /> 0 QSto Meterms of IIs g'N EPAAdneasnal adConsent. <br /> Wm-N NaIIMwdste mie�mPdaFl galeniant H.'MMEdndO LFRPfi2Y]fal fA area Nr9e puMelY 9eneralM1la d11 am piyn puadlty¢nefdlwls NX <br /> GeneratamiliNa /s PimadRYpaE Nark 59w1ure - Manor Day Year <br /> ar u <br /> 16.Inbmada-a Is <br /> F ❑Inponlo U S. ❑Excmfdd U$. Porldentrall. _ <br /> ? TranspMeni9n.dm(far exports only[ lJ Dab Neem,U.S.: <br /> W 17.Transparlx Adradm dgmed!of Receipt of Materials <br /> Q irar er1 Pnnldrfylytl Name M}rye D, Y. <br /> 8 Luce f} d S - <br /> i Tran rl ranging I Yed NameSgn MmN DaY Year <br /> So <br /> i18.Oisdownd, <br /> 18a.gsveparrylMiratianspaa ❑ OuanelY ❑TYPY ❑Residue ❑PNd Repmoi ❑FUFR*— <br /> Mail Rekrtnm Number: <br /> I&Manch Fanliry for General US EPA ID Number <br /> U <br /> fek FadBy's Peau. <br /> a� 18,.9Nneture of Altemeb Facalry(or Gerk21a) Monte Do, Year <br /> 2 <br /> V 19.NBUNous Waste Nepal MaragammlMdMd eddes(i.e.,mdeskr eazardgus wase treatment,disposal ad regGm9 systara) <br /> d. <br /> A.peagna1 deal Dinetof ala:Ce9f✓6and d bgpl d wzaNwS mal anal by M mdMest aarapt ea Med In XpT Ise <br /> 11dSig to Mon NY Year <br /> mi 5a7 IIIi <br /> EPA Form 8700-22 IRev.12-17( Previous sooner are otesofed, DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />