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—c UN! <br /> A-1 t#, — <br /> %3e a pant or type I <br /> tJh11FORM Hg2ARppGg i Gen@radorlONumlxr Fpm A <br /> WASTE MANIFEST CALM044=1 2��°°of 3 Einvoincy Frtatoarae M3 S rldnileat Tra6Ina Hum <br /> G nerrlor'S Nam2 arm Malmq Add ess 919-VI-5747 <br /> A8811i E iA► L V IFA1ad ; Genx'ralcrs See Address p44AtnnT man rsad ng ) <br /> Genuratoe,Phone xfl�! ll4tl7 <br /> 6.Tra%pmrer 1 CtHnpmy Nana <br /> 4A►I)rj 1'•;"Pqc � $ US ERA ID N4mber <br /> 7 Tre Porter Z Cpr f,pny Neme G^ um <br /> J S EPA+4 rknrbx <br /> 8 I]asipn5ted race ry room'and Srq Address U.S EPA IU t9urt�ee <br /> t1LrfiMI�Rp1�}1 Isis s RVER rm F1iAt 9It: 81 CAD044U <br /> '•'jMT SkCRAWNTo.CA WWOV <br /> FAc1Aty's pho,* G 16417"747 <br /> Ba 9h tJ.S DOT DesCrOH w(Indudng r'ropeF Shrpj"Name,RazarJ Gass.ID Nembef. 10 Coptemers $1 TOW 12.Unll <br /> HM ana Packlrpa Group ill any)) Nu Type ❑uanlity wt r•Jol <br /> a t 10�RL'AA"Azii low VOAST& Sow[t;*.BERMS, <br /> w <br /> w <br /> c7 <br /> 3 <br /> TH <br /> 14 Specjal Handirrrg lnstruciioru and Additional Information <br /> k+FflEtf7! *nwowip Ctil"F—%('(TRr mcPkPAw&I$V1 wo <br /> Ly IURD-EMS*9#U 0 BE T1W6W VC US■PI'%WL;[r PVf <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare Iha t the conren is of this rmrt3iQnrnenl are fully and accurately deswbad above by the proper shipping nai <br /> marked and Iabefea'ptacarded,and are to all respects in proper wridrLwn for transport according to appucatle intemational and rtabonal governmental regulations-H export <br /> Exporter.I cerbfy that Ihe.contents of thrs consignment confoml to t}'e tears of the atlached EPAAcknowledgmant of Consent. <br /> I ci r7]Vy Mat Rte waste minl"zabw stalemeat identJ50 in 40 CFR 26217(a)(if I am a Large gtiantity generator)or(b)(d I am a smaa quanldy generator)is true. <br /> Genera:lesliflf mes PrinredTyped Name Srgnaturs <br /> zj Ib.Infematbonal Shipments Y 1 <br /> ❑Import to U 5. ❑Ex port from U.S. Port of of tryf"d <br /> s Transporler signature(for exports only)' Date Iravmp U.S. <br /> Vtr 17 Transprster Admowfedgment of Receipt of IJsWlaiL <br /> w <br /> r Transpprter i PrinledlTyped Flame Signature <br /> O ' <br /> a : r <br /> $tr ¢ Transpoder2 Pnrt ypetl acne <br /> Signature <br /> ix <br /> �r 1t7 Discrepancy <br /> P p I8a.Disdepaeay IndicaWn Space ❑ Utfarr7ry ❑Residue ❑fttN RejeMn <br /> Ihartifest Rtlarance Number <br /> 18h.Allemate Faally(or Ganeralor) - if-S.EPA ID Number <br /> L3 <br /> � Facility's Pttdne' <br /> LU 18c.SlpnaVe aCD <br /> I A�emate Fadllfy{vr Gerlera3orj <br /> yViLILA <br /> 79.Hazardcws]NasEa depart 1vlanag8mentM4ff1 <br /> 3 fl in t • x <br />