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Pleese Millor bW, FofmApproved.OMB No.205 4M <br /> UNIFORM HAZARDOUS i.GeneraWr ID Nur be 2.Page,al 7.Fyne cyAespo tae Phare 4.NanketTraa&gNumbor <br /> WAM MANIFEST 023583381 JJK <br /> S.Gettaralals Name and Wiling Addrssss Genaremea Sita Address(11 W8 eM,halt milling addren) <br /> Oenemlpra Phalan-u» E i ... vr I� rar^...i. <br /> 6.TmhspwW I t;ommmy Name U.S.EPA IO Number <br /> ID <br /> 7.TII*jao ter 2 Candy Nanta U.S.I?PA ID Number <br /> S.Deftwlad FaadN Name arld Sde 0.i6t5s US.EPA ID Number <br /> Fedhbfa Prkale' -1:-::.._ <br /> 9a. 9b.U.S.DOT DeapiPbon(mcll&g Proper Shipping Name.Hazard CIlm,ID Number. 10.Ca+teircers t,.Total 12.UNI <br /> HM Emil PetMV G014(HXV)) No. Type Ouaabty WAU. 13.tussle Codes <br /> 1. <br /> e1DM �tfl►Il W-W FS WAXTF%OURS.ABSOMSE-W FS,d Cal <br /> , � n+sF'1•T'8 Tit.CRl3 <br /> w <br /> 19 2. <br /> IN <br /> IN <br /> 4. <br /> 14.Spodal Nptdltg Wou ow andAddiwal Imormalmrl <br /> iOR-EN 2Tt1{ IERS ERC,t rr <br /> MclapEriL .. <br /> 15. GENERANR'SlOFFEROR'S CERTIFICA71ON:I hereby declare that the oont0r,tu al lfiis=slgnmem a+afLil eM ax,,•a!*descroed ebme by the p opar enppbg name,and are classifled,pwk0gad, <br /> malkcd and Iabeledlplacardo,and are in all reapeds in proper condition to bensppl ectardirg m intearatw.na aye Ta!ipnal goverrTTw-aC mguta;iava-11 oxpoR ahilx e t and I am the Primary <br /> kokWar,1Cerbrythat Ile con tots ofellswnWnmemcardrnrntobtetamesoftheatladtwEPAklTcoad w,,ofCansant. <br /> I ON*hie[Se y21560 fulfttation Statement identiTed in 40 CFR 262.27(a)(A I am a Jorge cluan9ty prelA'Czi w jb)(lI am a wild qua"gleam,a M* <br /> t'renamlordO oWs PrurW&rypad Name Sgnabnee y <br /> o VIA a <br /> J <br /> 16.I wriall"Shipment$ <br /> H ❑fmport Jo U.S. ❑F,,W tl$Z.8. Podorelmyiasa' <br /> = 7ranspeder slgrelum(lor mperq only)- Baia laavlrg US„ <br /> W 17.TwopMerAd wutWWg tot Receipt or Maledafs <br /> Name G `�, d2 <br /> t <br /> ? Tram!t 2 ftvpW Name f� t rey;re <br /> �g Day Yew <br /> O1 Ma Z <br /> 78.Odaepancy <br /> t6a,Discrepancy Irdlcation ElQ.,* ElType L]Relp. LIPartial Rejection ❑Full Re]ectlon <br /> Marmlest Rofeme Number <br /> lob.ARemate Fadi (m Glawador) U.S.PPA 10 Number <br /> i Farift ohana: <br /> UJ lie.Signature of Aeemate Facility(or sertaralar) Mpnlh Day Year <br /> Me 1Me <br /> 19.Hamdan Waste Repan Management Marto Coes II.e.,miles for hazardous wawa U*OWQr(L dispasa(.and muyciR syetems) <br /> LU t 2. <br /> 20.DesignoW Fading Ownerg OParalnr.Cerli9mtlan of MOW ofhualdeus mater ata moored by I*mem"&,"as rdad m nem tae <br /> Ptin amukm(,Asignature Mmdh DDay Year <br /> 121 U <br /> EPA Form 8100-22(Rev.12 Previous edifiam are obsolete. U DEBIGNATFU FWCILITY TO EPA's e-MANIFEST SYSTEM <br />