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Please print or type. 0 FormA pproved,ONE No 2050-0039 <br /> UNIFORM HAZARDOUS t.cenaramr lD Number 2.PA,I o1 3.Emergency Reepoos.Phone a.Manihst Tneklrp xumbar <br /> WASTE MANIFEST - - ' SKS <br /> 5.Generalore Name and Me I,Address fainakls SeA Address(REMerM1 bead thee.,a63reu) <br /> Sd.rem(s Pbenn: <br /> s.TrznapoMr 1 Company Name U.3 EPAT,Number <br /> 1 Tmn,,ner 2 Sari Name U.S.EPAID Number <br /> BU FBP'llly NameanC Slle Atldress US.EPA ID Numhr <br /> Chili Prete <br /> Ws Far US DOT Descrosm ancluding Proper Snipping Name,Hazard Gess.ID Number, 10.Conatim rs 11 Thai 12 UAt 13 Weals Code, <br /> HM and Padang Gmup 4f any)) NTtype DU." W,Z <br /> z 2. <br /> w <br /> l t7 <br /> 3. <br /> 4. <br /> 14.§p Q HandNng lmWCNns and Ad®eorel ImmoraMn ).,_..., <br /> 3105i 9Ala 2a0 <br /> ±—tt, ars, -aeras a enc) <br /> hill I <br /> 15. GENERATOR'SIOFFERORSCERPFMATNIN: Iberabydafere NaltM wntOnp olMu consgnmenlare fulry and a>vrelelydesrfr above by me pro.rsMPprgrend,and am dnsMsd.pa&.,d, <br /> marked and PlaaedlplawNed,and are in all r�M Proper Pool for bale at dapding Id appal international and national goyemmental regulations.If erporl shipment And I am the Primary <br /> Exposer,I rangy Nat the Pnt..of this wrelgmnBM conform td Me Hands of Me maiEPA Acknowledgment of Ca <br /> C9rer�wnlry Matbeweste minlmhallcn aM@mmlldentlfied lob CFR2S2.2ild)Q110malaye g.nATy ganemtaa(b ' small quanNy gmerebrl <br /> Prin4tlRypANN ame g Mood <br /> Day Vear <br /> ILI 8 <br /> J 16.1 ISbgmen <br /> TransponersignaNmb perNonl,): ImIMd 5. ❑Expos born U.S. DAN,I.Paree.U'S. <br /> Aid 17.TrenspdnxAOmlled9menlol Re ipof MsNmK <br /> Temporal 1 Pnntanotyped Name SyaNm NunN Day Y., <br /> al O �OAr <br /> iTheroaddle,2Pandiald',peallkid. Month Day Year <br /> KS r \ <br /> 19.Dka q <br /> 18s.peae.rp lMvaaktri 5pax ❑ cadmi El Time ❑Read. Ellaraftellaaardeam ❑FWI RAMobdo <br /> ManiION RoferoMe Number, <br /> 18b.Alternate Facility for Generator) U.S.EPA IS Number <br /> J <br /> U <br /> LL Faoklys Plod <br /> aa t&.Sgreturecfeaamale Faaft(cr Cermals) Monts Day Year <br /> 2 <br /> 19.Hazadous West Repos Me., At Mai Dana(I e.,woes ter hazaNcus wash trestinent,deaddeal,am model system) <br /> G 1. 2. 3. a. <br /> 61132-- <br /> 2e.oesgluled Fetlgry Omlwa Opaelor'.CaNfiafion of re.iplol r:aeNoue meWiab o>.nred by Me mend texceplmnobd in abet l5a (a,ory <br /> 1 Ptlnhtl p l Name ignaNre 1111 lay Year <br /> A. 1 <br /> p <br /> FA Form R1Da22IRev. 2-1 revioused'dvls are obsoaMe. DESIGNATE ACIL E A's -MANIFEST SYSTEM <br />