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AP , <br />.No:2o <br />o-9 <br />UNIFt)RMHAZA{�DQUS <br />1 GeneratbrlpNumbBt, 2 Rade1. -f <br />3 F*gcI 4,RBspbns8Phone,; : , a AstlYaCldp N ti ry <br />WASTEM i>II�EST <br />440. �T"��Y1,, � <br />��� a� t���1�'} �� � iM ��� <br />a Genf ..' <br />I(ppdsAy`dO'tb S' <br />n�1 'y GerSbratbPs51 Addrp§s(ifdi eldntthah alliirg�ddresg) <br />I .1 %s(Jeme I <br />y_ Y t 5 ', y i l t tr F i F r ; ;'. <br />4 <br />4 fLA u: LS�iN &J'�.piS�±���.iLA6 .f �7iCF'$�±.� r <br />'n <@dA )pq <br />�i <br />1.. <br />puy`t�r $, )�Yy9.Y <br />p ,±.,tj. <br />p,+ s..l1Wgy� . r <br />'Y •i > <br />Bhp °m1P�c4�^A 'g4@W'ftyNy�,rA <br />#y,�ytT <br />�y �p ll'i,YACY+v'YlY4 :'�`U'Ay y <br />HS,{6"a.$. {i� t J 6a9t�"A 1 "'�tiA.Oa t <br />"u� `: °.. y'�,af' i , <br />Generator'.sl�fione rµ ;,.'.',,. t, <br />8d7ransporter 1 Compepy a{na r I ± U S, EPAIq o er <br />, , <br />' <br />qq' . % gg�u jL�� dd; 1 1 <br />$ ` F.�- e,7 d qfi� r. �K°-ik 131kLtl J •'t �7'�g yp +$ $�� gg •y S <br />V M.A Si?:Qe '$� <br />:.( As, 3� <br />' <br />. <br />7s Transportbr:2 CgmpenyName • :' ... • U,S EPA.ID';N4lmber <br />.. <br />:. . <br />-8,,DesigndtedFacilltyQno'%andSitdA,ddrass' - q.ggd., ';: ,'' U:S EPAIDNumbar <br />g. <br />p g <br />t .. $yyx {`pRBTYi Yip"Jg�.�c��,,�p�� 6' 0 6CY ,Y' ` ( �; .. ,_ t ' <br />¢' , p <br />'�±�b I r .rvy ���y ,� !y. 1 <br />'iiM ;d�°ggu t `.ikG'.i5'I,+a�+ ' <br />q.@��'yya1�W,��1�+„ <br />IIi.'�'�'±�iV 9rr � � <br />i <br />Kaci t h e y$ @ <br />11 <br />sP..on r'• ., <br />, <br />ga; <br />8b I S DOT Desc(Ipt)On (Ind Ing PropeC hipplhg Name; Oazard C(ps9 It HumbeJi <br />19 dant iqe s <br />114Toiel ' " <br />tJpit <br />I <br />Hfv1 <br />and pa'clilttg Group (It any)) <br />Qtiat)tjty <br />12 <br />UVt.IVol <br />�a, West e Cpp� <br />,.:. <br />c:,.. <br />7ylI. <br />u:•. t <br />. ...•.: <br />1 �• <br />r `' Lgc a <br />�� <br />19�fI ;I" <br />I <br />Q <br />`\ <br />n A � ; <br />a <br />P <br />: <br />Al <br />s <br />, <br />" <br />I <br />iG; <br />} <br />w/ <br />t <br />c. <br />a <br />'; 7 <br />(p <br />a <br />. <br />.' <br />:. <br />A. o :. ... :•. <br />14. Special anditng Ipstructions andAdditlonal hk?rnation I S r�" <br />t <br />5?%�,.C.@ ��'CeJ.6 til rt A,f a r7'7,. �ry�9.YN�� - � �� � <br />y' . if. <br />feIP ����(��'4���� <br />a�l���a� ;.l <br />15 GENERA'(QR'SIoFFERoRSCEtttIF1cATI0N;.lherebjrdeclardthatthecontentsbf•ihlsconsionttiantarafully'gnoacc4iretelygriscrJQeo:abotiebyjli propgfshipptngname;?.rrla{vciss IjlQg �aokegad, . <br />marked I f , labeled/plaCafded,and are in ail ras�ects in,pro ;er condition for transport acbording'to appllcpbl@;.IrJtematlonalaji nat(onat goveifimeptal jagul�titlns; af,export shlpmertt antl I a[q th@ pd ary : ; - <br />Expptter, I:cerlify 1haltl� contents gflhis coryipriment dop(orip to the tenets of the,@Nached EPA'libKnowledgmehl oI Conseht t ; <br />cridify that the waste rtii iptizrit)oh7slalelrient-i(7i p fled in 4S'. FR.262 27,(x} (ff I am,a; irarge quantity, gQg9Pa(ot);or (b} (ifl a t.'a st>?gll guar lity gen00 t tru6sI <br />LI) <br />Ganerator sl s t y? Name{{—f,��+ }r;tt �r�� p, �y��yy nn (�p�} SlgnaOluryrje . I Mop)tt DaY YgAt <br />. 94 Jl �1 1 <br />{ d . 1<p1Ap rI . ,A G <br />+0.f �'..4R s�9,C^i C,-¢�,f - i / +1, ., - <br />F <br />q{' <br />i 1 y" , 4, i�r h',tt 5 <br />. �.l , .}. t, . k rF A <br />m <br />1 s:Interneflohal Stilpme+lt#t +'. <br />Im p f4 .S, Ftxport from U S � anirylextt; � j^y " t sr �, � r : <br />I.4 , art � Dat�of <br />, orfs on•I . lbaving U S.; '— f T <br />7fa s er 51 • Nature for eX <br />n 9 ... y) . ,.. <br />,.. . • . .. ...:'r <br />17; Transpor(sC{�c(CnpwledgmbntafRege(ptofMafgdels ""r <br />Transporter 1 Pilntetll7yped 4 .< :: ' Slg r _. + Month � Da Y o ' <br />eY I <br />;: ... .... :� <br />Transpbrier P ntedlTyped a Sig qju , Months Day ! Year <br />'. <br />,; <br />18: DisbfapancQ t <br />18a Discrepancy IndicallonSpaCe nr—� <br />QUanthy 3 r_,_1 Type' )� Residue O Partial Rejeotlon Fuli Re)ecli6lt + <br />p <br />, <br />`rnb <br />fulanifest.Raferen e,N r. s F <br />I <br />8b Alfer a(a Facility [br t2anatatoP) tI EPI. Numbdr {{ <br />. <br />Facilitys Phona; <br />w' <br />•lac SlgnaWrd of Alternatb Facility (or Generator) Mor} h Dey 'Year <br />, <br />;. � .. <br />19;,Hazardous Wasta Rb in Mana bnient Mothod Codes, f 0 cg es for haZa ous W�sie' Ire 4nlent.' (s <br />P 9 ( q aP <br />osal ani recycVhg systems} '' .,, <br />h -'. 2 i <br />1 ` 3 4 <br />I, ��'. �r t l�� <br />1', <br />to r)yvner or OperatBC S3enificatioil of r8c'' A t (hazardous ptatad coveted by the tI stexcept as actedirt Item 18a. <br />.Dasjgpate'd.Fabllity I F .11 <br />Prin edl7ype NamB " a Signal ro ` Mgntll Qay " ' Year <br />' <br />} `• F l A J ! }l,[ iu. e, pJ"ry l! M`'r i J± <br />f ';. ". 1 -i <br />! f �%F f( /� F. A t�� l y r'�, S� I r A ,.p <br />EFA�Fbfm <br />87bt22 (Rev ,.2•;17) Pre�u bus edi ons Are obso ete ";: " ; r I TRAM RiJ f R< 0 <br />; <br />