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� NINIINIIIIIIIIgNIIINIIIIIIIIIII <br /> Please pend or type. 4'3 /'i a JIlQ J 0 0 FormApproved!OMB No 2050-0039 <br /> UNIFORMNATARDOUS t.Gave lorlDNember 2.Rea Iof 3.Ema9enryReepelmPrgne 4.Ono77�9149 SKS <br /> WASTE MANIFEST O <br /> 5.Ganvermi Name and Met,Aadress GDI'2ma'e SINAddav 1Nmaamltlen maTrg address) <br /> 6GeminrnerponmMPhase <br /> . ler 1 Cenaany Name U.S.EPAIO Nulled, <br /> 1.Tranapmer 2 Company Name U.S.EPA ONo. <br /> 9 Deegnbe Faady Name and Site Morass U&EPA ID Number <br /> Fall Phrome <br /> N ab.US.DOT Deentton 4mudiog Paper Shipper,Name,Hazed!Class,ID Nodded,, 10.Central 11.T" 12.and 13.WFeq Cann <br /> NM dna Ped�ng Group lA amu Na, Type Go-* Ill <br /> 1.— 1 p �.N 1160�w <br /> i z. <br /> w <br /> v <br /> 3 <br /> 14 <br /> Id,Spnal Handling lnsWcbme and AaaniOnan Information <br /> �. b Outya S <br /> 15. GENERATOR'WFFEROR'SCERTFICAPON: I heraby dedare Palma wotan6 of Ins overall l are fully and ac—ley beachhead above by the proper shipping name,aNa.dassdae.packaged. <br /> maMd and la[elebarrel and are in all rnkud6ln p'epttamaihon for banspan acwrding ed ap0licable international and mhOnal governmental mJumed, IlmFM enipmenleN 1 am Ne Primary <br /> Easmter,I WiN that ae mman.MNie comparmenteanlam a Mearns al poached EPAACNnoMeagmem of Consent. <br /> I mtlry Met Ms sale mmtmlzetlon eatement dendkdln d0 CFR 2622ga1(dlamelarye 9uemry paneredq or R7(tll amesmall9mnliTy gaamt 11s fNe <br /> Gem.la'Argbola <br /> Partleamed Nam Sbredn deal Day Year <br /> F <br /> it Iawte U.S. ❑Effort ham U, add ofannyedt <br /> 2 TJmyvltr aignaase lm eapare a*) Dae)damp U.S: <br /> do 11.ThimpelrWRe dM <br /> unapt 1 Pamemm, ) �, SquOae Mm Da rear/ <br /> rrptgpnerzPmmarryyed N.m.,4M•^' Monts Day Yea <br /> C I GAtNaJ �� O ZS 2 <br /> ito�eparry IN D4Vnanay travel Spare ❑ deal ❑Tyye ❑Peados ❑Paha Repan ❑Fall Directed <br /> lee Alternate Faclldy le GenemtIXl MsrtlMPelasrn.NtNrter US.EPA 10 Number <br /> U <br /> IQi Facility's Photo <br /> ad 18c.seemed.ofA bamem Fal her GnaaNO Month Day Yea <br /> Q <br /> 2 <br /> � 19.Hazardous Waele ftepon Management lMRol C[Em(I.e..better for h,Rua MEIe PmMenlNot and reqndJnelane) <br /> N <br /> 0 1 2 3. a <br /> M 1 <br /> 20.Davgabd FlacYry OrmerIX Opaebn.�Ory dlkmrd.s MO@ lsmyeeabyMmailwlempin rWddIbm a8e <br /> 1 Pm ped Nam Someone1- MmM D y <br /> Fe 1 ; )( M Ico 13 126121 <br /> EPA Form 8100-22(Rev 12-17) Previous edilune am obmkk. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />