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Plo=Is=, print or typo. Form Approved,OMB No.2050-0039 <br /> UNIFORM <br /> A <br /> to AZARDQUS 1.Generator ID Num4 Ar 2.Pag�e71 of 3.Emergency Response Phone 14.Manitast Traeking Number <br /> WASTEANIFES'i G 1— 01 JJK <br /> t nnaYtoi s N€ime snd Molliny lsrldnass �k Ger atgr's Site Addross Q(dl rent than malling address) <br /> goo A; Ia A46. <br /> U.S. ID <br /> d r�narakpF,r.,f hong - _ ��'✓�J !%'� ���'Y L- <br /> ri�i�<+nsportar 9(,qmp env Nam- EPA Number <br /> 7.Trnnsportor 2 Company Name U.S.EPA 10 Number <br /> f3 UF,a nd Farlllly Name and Bite Addres.. } 1,. !�1!r{. �'f /�C' tl U.S EPA ID Number <br /> —v 1, ,,_1 <br /> ga rib U.S DOT Dosrripilon(including Profwr Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Picking Group(11 any)) No, Type Quantity Wt./Vol. <br /> 'ell <br /> 4. <br /> res <br /> i <br /> 4 <br /> 1. Sprcial Handling lnstructimsand Additional Information <br /> /?t'114f-j J k v s rz C <br /> 1,. QENF.:fIAMR`S(OFFi ROR'9 CERTIFICAT1ON;I hereby declare that the contents of this conalgnmant aro fully and accurately describod above by fhe propor shipping name,and are rt,�e:Wwd,packaged, <br /> markad and labelod/piac rrded,and ere in rail resprels in proper condition for bansport according to applicable inlemationaland national g m la!regulations.IFoxaM sniprrpont and i am the Primary <br /> ExIvior,l corfify that the contents of this consignment rxmfornt to the teas of the aaachad EPAAckrimmedgmant of Conaeni. <br /> I cerin !h tthe wasto minimization statement Identified in 40 CFR 20227(a)(if t am a large quantity generator) r(b)(IflantgWallif Iffy nerator)is hue. <br /> -Go frato1,416faror' R tedFTypedN ame Signature Month Day Year <br /> „,� '18.Imam9iinnal Shiprrtents <br /> ❑Import to U.S ❑Expwl from U.S. Pon of entrytoxit <br /> ? Trampurier,,Ignature(lot exports only). Date leaving U.S.; <br /> E 17 it nrtfxpdarAcltmpwk:dgm ntaFR^.c�iplafMatacyels ,� ; <br /> 'T1an5porter IV40,tednyrxd Nsmn w1 �A' S#gnahrr 7` Manth D^v Year <br /> iL <br /> r Signature Month DaY Year <br /> p f _ <br /> Trans�r�erl lnlar�'I' a1e <br /> 18,Dlscf-wrley <br /> IA,Discropanry Indication Span t�uamdy, Tye Residue( Partial Ftef.ka l !Pull Rejeotlon <br /> �.� I,I � <br /> Mmtlfest Reference Number; <br /> f TV-6.Alternate Facility(qt Generainr) U.S.EPA ID Number <br /> C?. <br /> iii f 1 W SWIM(116 of Altemate Facility(or Gomeralwl Ma=nth—_Day Year <br /> It- <br /> 19 HDL,rdous Wa.str Report Management Method Codes(I.u.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2Q Duslmnnl J Fatlliry Ovnrar o Operator,Cnrditcauon of rawipt of hazardous matenais cavamd by ma msrrrfeat except a clad In Item'18a <br /> nate TynnN+una gnat re P th r <br /> L <br /> PA Form 1700,Y(ftcnv,t 2 i 7 Prev ous 0r frons are 0bsole DESIGNATED FACALi IF z TIC)EPA',,,-, e4el NII F4,( , S r;n;10 <br />