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Tease print or type. Fwm Approved.OMS No-2050-0039 <br /> UNIFORM HAZARDOUS 1 Gena aYcr ID NumEer 2.Page I o 1 Eme gancy Response phore 4.Me 6feri Trading Number <br /> WASTE MANIFEST ?DV 341*-74111 <br /> 5d 2 3 8 2$ JJK <br /> ,GeneraMts Name and Mailing Address GwwarWt Sile Address()f ddffsenl than mailing address) <br /> Gene.Ws Phar": -6a17C 1 I f(11-4 f a s!41) <br /> 5.TreruperW€Comperry Nance U.S.EPA N}Number <br /> 7.Tran-w.,2—Perry Marne - --GuJ_--- <br /> -f'(-.CVM:)E qE OVE- - - TP r,4!3 U.s-EPAION,mber <br /> 8,Designated Fapbty Name and Site Address <br /> CRR4iD�1?5r'�. <br /> ,:I114t1t, 0.5.EPA ID Number <br /> Faci4 S PhonB'... <br /> SO. gb-U.S.DOT Dssoiplion(inducing Proper Shipping Name,Hexard Ossa,ID Number, 10.C.rntaefers <br /> otal <br /> MM and ParJdng Group[d arry)} 12.Unit <br /> No. Type Qu Tanzitr MAW. 133-Waste Cade. <br /> 1- <br /> o °!r rH-RC PA K4'TARL"1i.klS Wd ::I-: a i%75 ABSf—aaliENTFr c �I , n + <br /> PArl..F'RLTFrit M 11913 G <br /> Yea <br /> w 2. <br /> Cr3 <br /> 3. <br /> 4. <br /> 14.Special Handling Insn amps and Additional Inrmmauo� <br /> VID tY 2-4-7 <br /> 15. GENERRATOR'S)OFFEROR'S CERTIFICATION:I hereby dedarethot the aprlerds of W wmlgnmml a,'e fully and acauatery described above by Nm proper shgaplr3g name,and aredassMetl,packaged, <br /> marked and labefedlplscarded,and are fn eb reWecls in proper conciftn for aamportaccordingic appliesble intemafionaland natonal garemmmtai regulaba,,e If expos shipmerN antl I am the Primary <br /> Exporter.I cMN lief the contents of Nis corsignment conform to the remls of the attached EPA Ar mwMedgmerd of Canserd. <br /> I cerlify that the waste minimize.ban statement identified in 40CFR 262.27(a)(ir i am a large quarditygeneralar(m(b)(dl we slab quanWgerwalor)is true. <br /> GaleratcesicKnoes Pdn6ed/Tyed Name Signature Mgn6y Dgv ar <br /> iZ040wdllr]_r? 1*ifD�7 Y /} <br /> 16.Intemallonal%pments' <br /> 2 ❑Impart 11 U.S. Ll Export from U. Part lex <br /> Transporter etgnahrre(for exports only): Date U.S.: <br /> a: 17.TranaporterAcknoWedgmiard of Reeagd of Maletals <br /> LLI <br /> rx T r 1 Pdrde ped Nemo 5 MonthDay bar_ <br /> l /y <br /> aiarapo er yped Name na Mordh a Yozin <br /> ear <br /> F <br /> 16.Disaepancy <br /> 18a.Dimreparxy Indication Spam ❑Ouanbry ❑TYpe ❑Residue <br /> Partial RsKolon ❑Fub Rejectlon <br /> Manifest Reference Number' <br /> 18t.Alternate Facility(a Generator) <br /> U.S.EPA fD Number <br /> U <br /> Paatitys Phone: <br /> W lk Signature ofAitemals Faptlty(or Generator( <br /> F— Monty Day Year <br /> Q <br /> CD <br /> W19,Har_ardorls Waste Report Management Method Codes(i.e.,codes far hazardous waste bealment,disposal,and racyUng systems) <br /> o t L 2. 3. 4. <br /> Ef <br /> 20.Designated Feeday-P•nor w0pereter:CAmpatvn of receipt or hazardeua mafedala mrered by bre mantrest except as noel]in Item 182 <br /> Pd yped Name Signature Month Day Year <br /> an— <br /> FAFomB70022(Reu.12.1 Previous eddionsareobsolete. V <br /> kGNA F ITYTOEPA'se-MANIFES`T&YSTEM <br />