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r <br />"Ja <br />NONHAZARDOUS <br />WASTE MANIFEST <br />I Goneralor ID Number 2. Pagel of 3. Emergency Response Phone 4, Waste Tracking Number <br />5. Genvatore Name end Mailing!AVicit 1 #0294,002------- GenerattgZgr,*(iggren 146kr—t ma <br />ivion Est thilliks DIs 14 51414**AndersaMunkl <br />pa <br />.. . 952 <br />'ft- <br />- <br />9 Transperfen Coniptifffrgyt"' u'l U.S. EPA ID Motel <br />_ROWEtraitVIRKIfileritZ4-SELOCE-$ I C'Alt001 0,1 8 0 7 3 7 7, Transporter aCompeny Name U.S. EPA Iii Antler <br />I <br />• <br />' <br />It. Designated FaCifity Namevid She Address <br />POV'EfOtt*T• LIMON • ':•• • <br />3675'Pardro Hib in.. <br />Faclik AIM CO'. C:/. 9455 . . . <br />U.S. EPA ID Number "i•.:' <br />70741211S ----eikfteiH14)43-9-+6,6 I S. Waste Shipping Name and Onscnoion al : ia 4mrs ff. Tot 1g. Unit <br />. Typt Quantify VYtAfal. <br />6 a X <br />E5 z '•___, , , <br />1. <br />.0,0k. <br />azardousWisteUktattirescarboafropectedV a al , <br />.. ,t usi (5 i <br />- <br />--i <br />; 13. Special Handling tristrodloneand Additional Infornratien <br />1111=22431 .,,,..pctic • .,, • <br />'‘Iiibt2246.629 <br />rr <br />1 0 <br />L <br />4 <br />14. GENgRATQFS/OFEROFIS CERTIFICATION :1 hereby x dare that the contents of Ibis consignment are hilly and accurately deScrttled above by the proper r ',aping map, and are classified, packaged, niadi ' and labeled/pi rtded, and a hi ell respects in roper nardlIon for transport accordr.g to, applicable internctionel and not •ogmmontel r . I ens. <br />Gc siOffernee P rued/Type d ame <br />-:7176---. Sivaltsnr Moniti 0 y Year ' , ,Z <br />Z 7 d ---- , • , I / - 1 1 w T•••• 15 Memational inenfs :Import . U.S. Export from U.S. • not smile E ransporter Signal:1ra (for mods orly): '' Date leaving U.S4 <br />cc w 18. Transporter Ackpowjedgment of Fie.ceipt of I gabs <br />0 <br />a. <br />Traci . x Ho n edayped Name a,ety ,/: Year ., ..".- Z 14cn -. , Transporter Printed/Typed Name Striatum Month Day, Year <br />1 I I 1 <br />' <br />Discrepancy 1 <br />17a. Discrepancy Indication Sem) 0 amity 0 Type Li Residue 0 Partial Rejection 0 Full Rejection <br />Manliest Ficierence Number. <br />.. <br />•• <br />-J <br />F3 <br />t7b, Alternate Facility (or Generator) US. EPA ID Number <br />Facility's Phone: I <br />V <br />Full <br />I-a z 0 <br />I7c. Signature of Alternate Facely (or Generator) Month Day Year <br />___1 I L „,....i <br />w <br />I <br />Designated Facility Owner or Operator, Ce lion el tempt er a dais rered by the manliest except as noted In Item 17a iil Printed/Typed Name Signature <br />I <br />Vir <br />kir <br />' ii <br />* lk <br />-. ESJd'I ATE C) FACILITY i 6 1