I m t A, .
<br />} .' t. y. ,
<br />:, me
<br />1
<br />k
<br />I do
<br />.I A.
<br />�- P
<br />please pant or type r, rmIsr: A, r iA.mod �orrnApproved MB No 200 00
<br />UNIFORM :FiAfA�t174.fJ t 1: G9{ieratgr (D•Nu,'mbef ' `i+At A Am F ; 2' Pageaid, a 1 of, 3:Emar eric 'Res a
<br />9 Y posse Phone 4 Mhni e$ Tyapkin Numbep A
<br />WART AAN(F $T.S :,. `Tat ad � t��, allPAA.IA er 3 F1 o )< f
<br />IT 11 For A did Art. 6 Fit S��I
<br />5, Gs(taratorS Name a d:dailing Address 1, 3 ,' I C�Qge oto $ i(Q' dre s (I(d fforent t an rn§ Ifd� addf§ssj
<br />§AM a ., i
<br />4.00
<br />" ( ° '& ltAAwr
<br />Generator's Ph on'LI�t,"Y0 ,,w`�it ACA .9;§ Im ; I,
<br />do
<br />8. Tfanspottet 1 Qomp1. any>Naq}a 4 I
<br />LIP1.ILI
<br />i'.US EPAIQtd (tlber
<br />7: Transporter 2 Compahy Name Us; SPA (D Ng4. Imbarfer
<br />i LL A ,at IF • I ,'
<br />. ,. `
<br />At iLIP id
<br />8i DeslgdatFL I ed; Facility Name and S1tB Address
<br />y $ { pp U,6, EPAIq Numbor ,
<br />'F�A me
<br />wd,.$�.a ti'e+�.doshl`L� 4 a..0 wISO I ,' ,
<br />It,
<br />I A
<br />Facili ;a PA = u �� ,.�
<br />Pal +I
<br />ga 9b tJs CSC�T pe4sription (Indu',ding Rrgper.Shlpping Natrw Hazard Qlass ID Number, 4 .Containers 11 totai� I 92 Utlit
<br />ypE and P.acklag Group (If any)) Iq 1a Wase Qpde
<br />ALI �n qr yyford
<br />y'4X Aj .} ` No Type Uant(ty FAAI; Wt Noi z; t :.y;,y �gy ;,,,
<br />1'[z?8 JA f �, '� fr /Si�9i R.x7 y�i QD W t ' 1 5; y.• t l�t Ai'f.79+
<br />d.
<br />(1a ,.
<br />OFF
<br />''i.L. i tIF I -
<br />.. , . ..
<br />3:' •
<br />S
<br />A
<br />r
<br />t ,IF '(``
<br />11�
<br />1. tIt I .A
<br />I
<br />?'.'
<br />I,
<br />4 Specie['Hand,linyiastructioh§"andAadltion'allnfofmation r;
<br />OWER'-�a � T� RM pop AllIa IIEX ' #vis � � �R���ri�
<br />',
<br />!'.:i€9R
<br />,:;
<br />15 GENI;fA ell A I IOFFEROR'S CASA I CATtt)N I hereby dec(aro t atiha cgntant8 of t i8 con)il` nment are fully rq d acqu(a{el da cribad abo $ b"'the ro er Sh! In 11em ?aM a e a 8
<br />{ :: , A. ':, . I, R . ,..I ,,. Y A. I. y: ,y.... R R pp 9 @,I (d ss1 ad, fiackaga ,
<br />1.marked and Jsbele'd/plagardad; arjd are In qu re§pecis 1n roper c.;t Ari.{qr tron p' it agcordir)g o; a pliga6 e.in(empiipnaland naf14Ao1 gvernhle lal re ulatlon f: slit me"E hd We I
<br />A. I A. A.P P p ( s n ,,, f! s,� epgrt p nand m primary ;
<br />> SxporteI I ger8(ythat the conten4¢ ofthis cjrnal nmelSt conform i the lerjns of the k �8had pAApKngw�edISA 1gnrerJ{ of Oori¢gtjt ;;. id Ad I I
<br />;, III I AN A
<br />' • I certlfy,lhatthI w �i4 111 iXatigq I smart{i�tlell I II 1n 4Q QFR 262 2j(a) (If to a.fR�p gfiaritity g�ner�t0 � or (b),(Ifl aitj;a s Loa til gi(2rrtlty genafator) is trtf� ` S`
<br />GenaratoPsl t s „da Ad SlgneCu ' , M6tlh ay r�
<br />18. (nterriailo(ial ShlprbedEs• � 3
<br />Import to U Sxportfrom U S Par<of entry/eXl(
<br />- . Transporter11 A'signatUte (for,eXports only)i Ddte (eaVing,US
<br />i'T. TransppitetAcknowladgment of ReGelpt of atetiafs
<br />M Transpo er !nt d AM Nahie S � Latta IT I % AA A f
<br />«A� AtA or I FT
<br />,.I+,,
<br />Transporter kddd"ddddk` AdoPrintatlRyp%ed Namq A 11
<br />1�. Slgaatute o i Da r. Year
<br />Y
<br />18, blscr$p@noY
<br />;ti, a =
<br />jea Dlscreparicy indication Space i , f
<br />.II Quantity I Type Resldue partial Rejectigt� Full (�eJe ton
<br />r r 4
<br />1 M'
<br />Ad A
<br />16b Alternate achll or Gehetator Refe n e Num f
<br />Y ( ) } anifest req `bar
<br />a.
<br />U S FPA ID Number
<br />Fachitysl'hone1. r ALIti OL
<br />. tIL
<br />99 .1 o Sighature . A 'Fal mato Facility (orGeherator)F Sp
<br />A 1.
<br />Ft I
<br />IlI IAA pad I I I
<br />rfi so P:
<br />4 19 AHazardA.ousWa'sASIA.loRQpgrtMan smut eihod J.otlabF(1a b{%A.(gsfatra,IFiG.dqus kdsta',reatmont;disposaP.l and Recyclingayst$rrjsf
<br />�, : 9 A _Pal A
<br />/'I'm r
<br />2t7: Dq§!gnat@ at AI'm Vi a 5 :t r qr Operator Qarifega(.(on gfregetptqF, �ardoas aA 1:W lals euvAA'ered Fri.,yjtte m fest e011Axcept as Add need in item leaI%Y ''
<br />I 44 RrntadlTypadNama� �, cr = S r �� ;
<br />r "z v✓ 9d th yr Yar
<br />,�d� ,�*A. p ,'a
<br />Sam,.Fit
<br />t A `' jFAA�itf Y _�{' �+'(� ✓ ��/r it 1 ?' � 1 r4�:(�t ��„' 'emadµ''+;.. r�i� , � .':.�A A _ ! i d�led �'� � /"'3 , r 1 do�(+ ,:
<br />UpA Porni 8700-22 (Rev 1217)' Previous edtt(ons are obsolete TRAM PO ERC RY
<br />
|