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r 01l or atm r1puoyed +lAb No >050 0039
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<br /> i I r=i I r rtirIM f IJ it for ID Number ?Poge I or 3 Emo genr y response Phone 4 FAhrtlfcsi 1r h 4(ng fdumhFrr
<br /> 7 f1 f9 ( t fr # r1
<br /> WO 379 5747 � 2
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<br /> ria; f nna ;;!Moling Addre n Gonoralor's Sito Addioss(it d;(forant Then madnasf nddress)
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<br /> ,+ i��+,pnr,; I r,ua perry Noma tl.;;.i PA if)Nnmher
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<br /> 11,total 17.Unit,uJ A nat CrruP(fany))
<br /> 13 Waato Caies(includi g Piopor hip nngbamo llacr l 10 Plumber, 10.coolalnn
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<br /> Typo Quanliiy W(lUoi.
<br /> I � boat . 1'111
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<br /> tEf :;r ti 14 f hF f4t fi S+t R f(f(CAff+JN: I hereby d2el ru that the aunt2nts of This consignment are fully and aeruratciy described above by fila Proper ahlpping name,aril are r 11rinificd,pZokn9od,
<br /> old alit,I 1 uk dloh a ciucl,c old aro m all roepacls in proper condition for transport according to applicable(nternalianal and notlwal govemniental ro91Ji800ns If export shipment and I am the I Irimmy
<br /> t rAo!fly lhaf Ihr on'(nl r of thit.wnr.ignment canionn to(he(enols of the aUarhod EC'AAcknowledgmont of Consapl. y
<br /> I rlriw II thr z Ir,r unu t tion t ieim nt identified in 40 CM 262,27(a)(I(1011 a Iurga quantity gonorator)or 1151(rf I• "as111 `
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<br /> ( ; 'i, du •pfd ; ( Inti Ihyp d rias SI nahrr ! _`� ,_
<br /> r hent+ Oay Yn It
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<br /> L�Import to U M ._I Expon from U.S. Port of enlrylc xit _.._
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<br /> ( axpnil,only) Gate leavingU,S.:
<br /> I i r n.n por:ra,ar,k,,mA_dgmcni u(rtece;nf o,6"ale;i;tie
<br /> Iii Planw s�Wum '
<br /> Month troll, Yc r..._
<br /> t ut p rti I yf
<br /> 1CI r.i I
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<br /> o i u;Ir•it l a t I' nl,. t, r .dna _.___ _ ` . ..�
<br /> 1 SrAnnirr Day Year
<br /> ,.lr,,nr/In,hrsUnn_::mco ff r 7
<br /> �J quanUlY 0 Tyha U Residua (J Partial hc)oclian L..�full Ilef„chon
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<br /> fk
<br /> Plumber.
<br /> ijw
<br /> 0.6 EPA ID Number
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<br /> part h+ amuif Mo h ad Galles(im.,code for h r71RIC u9 u'aale Imalnrenl,diopoisirti,and raoyt:7mg ayslvmq
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<br /> VotJliy(aunr;of Opo i)(!)( Corglieatiou of recoilpl of lunardous mat 1`11116 coyared by the manifest except as ratted In Ilarn toe V W
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<br /> . I`r;.0 t+ u(1?/thr,v I d-�I f) 1 Icalr;u:,utllhans Carr.ohaolp(e, ,.. , , ,
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