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Please print or type. 4 GENERATOR 1. I UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number
<br />CAR,0002S-ct 437_
<br />2. Page 1 of
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<br />3. Ernergenwgarogay_h2risL , , „.
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<br />I VIII( inlJp1,..0,l1. VIVILI .U. /-,./.11.MIJUU
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<br />U '•3 GBF rly Generator's Name and Mailing Address Generator's Site Address (if different than mailing address)
<br />P-0. Cox 80g/8 S:TOGICTL),IJ tag k5.1" kcc, Li_ C, STOC 1,-(X my s;"rsorwilk SC.1. 9480 KTbki , icT-LC, L L c
<br />4 kSci vir3RitfLrER. C-1-`, Gertria ply CIS GO ) 2..C-Ii - GO i k I '!yrocicrok), cA 9szot Transporter 1 Company Name U.S. EPA ID Number
<br />)1 /41R.0 4)ki 112.0k1A4E-nrrAL S_tRuicc_c; i MC. I CAR occ>0301 t 4 7, Transporter 2 Company Name U.S. EPA ID Number
<br />I 8. Designated Facility Name end Site Address U.S. EPA ID Number
<br />Ot tC-,01.- OW gE VA DA
<br />hwv 15, it mkt. Es s or sik-rvy
<br />16 EAT; N EvA DA SI co3 Facility's T on .y I kV-T-3-30Di 00c0 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11, Total 12. Ur.lt HM Packing and Group (if any)) No. Type Quantity 13. Waste Codes Wt.Nol.
<br />1' ;JOU PICRA MZAROOLLS VIAS15 50Lt D
<br />DAA '2:goo 1' -352 , (D i Es al- c.pkyr-AkA i Ki ATED UN ) r-X) b
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<br />14. Special Handling Instructions and Additional Inforrnation - Po **, 1 s g L41.4 2...
<br />(18k) 01017-S3c42 -2.,SA 2- C ) C47X Sok 1 e>40-7o \2s 3cx)---2 7 8oS olx S-5 DM 163)olo k--21tsic) -2-43.1c) ekx s-,-DA4_ 15. GENERATORVOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid are classified, packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. It export shipment and I am the Primary Exporter, I certify that the contents of this consignment °onion to the terms of the attached EPA Acknowledgment of Consent.
<br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if lam a large quantity generator) or (b) (if I urn a small quantity enera ton is true.
<br />Generatinesi!Keroes Prtnted/T ame Signature Month Day Year -7 t)i,-)-/ • I (DI,/ .441 I h I _,
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<br />16. International Shipments
<br />Import to U.S. Export from U.S. Port of entry/exit:
<br />F. Transporter signature (for exports only): Date leaving U.S.:
<br />ce us 17. Transporter Acknowledgment of Receipt of Materials TRANSPOR1 T )orter 1 Printed/Typed Nemo Sigrre Month Day Year
<br />A. lz" 0... -"I_ -1 t-----( 'L.-
<br />.,, V. __,_.„________
<br />I V ' 1----1 .-----"'"---------. I Ii 1 2/ I Z•Z- spotter 2 Printed/Typed Name Signature !,!onth Day Year
<br />I I I 1 D FACILITY -0. LT, 18. Discrepancy
<br />Discrepancy Indication Space Quantity Type 0 Residue Partial Rejection ri Full Rejection
<br />Manifest Reference Number
<br />Alternate Facility (or Generator) U.S. EPA ID Number
<br />Facility's Phone: I
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<br />Signature of Alternate Facility (or Generator) Montn Day Year
<br />I I 2 rn LLJ
<br />19. Hazardous Waste Report Management Method Codes (ie., codes for hazardcus waste treatment, disposal, and recycling systems)
<br />1. 2. 3. 4.
<br />Designated I I/03g
<br />20. Facility Owner or Operator: Cerlifica on of receipt of hazardous materials covered by the Manifest except as rcted in item 18a
<br />EPA
<br />PrinKla
<br />triki Let.
<br />I Signao
<br />Frwir71.7) iP v 19-171 Preauirvic arlitinne ....e...4..."1"1., ../1
<br />4 Month Day Year
<br />A 7.6.-) I / ...- I ) I 7 ?-
<br />s' DESINATED FACILITY TO EPA's e,-MANIFEST 3 t STEM (
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