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Pleasd print or type(Form designed for useo s elle(12 pAch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Can a ala 1D Number 2.Page 1 d 3.Emergexy Response Plane 4. nffesl Traek ng Number <br /> WASTE MANIFEST CAdca xg(#8114 { 800 'LzK�41.T6 015 8 2 314 JJK <br /> S.Denerator c dewsAla1'+ngMAmss Generale'sSAeamt and op Address(ildf2renlNanmaxngaddress) <br /> iq �o6kNS91 Joao e,A)IT•N <br /> ryQ.1 c1�R+�1.se,r (lO 9*E ryoo <br /> eocw ea091-K1E, rA'j t6-f-dyj ATQ�.P (A q"3) <br /> Gtncrabfs Phom: Q r(v <br /> 6 TnnspOner t Company Ma na U.S. PAID Number <br /> ("�rcc Eir✓rtaa�r��.i e+r vr40t d-,410 b 673N b G 7 9 y <br /> 7.Trenspater 2 Company Name <br /> U.S.EPA tD Number <br /> 0.Oeiona i$per <br /> OF I I. .S.EPA ID Number <br /> of Y <br /> R �Z <br /> L� f �tSArJJr•Sf C <br /> rail <br /> SRaf 7wfQ <br /> Faoi�es Phorw <;Ia'p d S9f/;7Y 3, <br /> ga. 96.U.S.DOT W-0-(iidudirg Propor&tipping Nam",Hazard Class.ID Mmber• 10.Corxalnters 11.Total 12.Unit <br /> HM and Packtg Group Pf any)) No. I Type Ouantlly WINoI. 13,Waste Codes <br /> o ' 06d-Rc%kA M}A.1Qieo"j N4¢s�, Sac.4 of <br /> h.� 3sz <br /> D!`bfcet CarlfA�M11M4-►�Irl O(� �,� ✓"l �4U P -- <br /> w <br /> fir 2. ' <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Hanging Imtry dom and Arkaeorul wormaeon <br /> WEAR �-ftfe fee PIPD�ILE tr,} CObi-I&313 � so# rao3349s'e$ <br /> S00.4 4\'%a-o02t3 <br /> 15, GENERAT0R'SI0FFEROR'3 CERTIFICATION:I hereby declare May cormots of IN,cwsigrunent aro(city and ao ra+ely desaW glow try the proper itlppVg name and are classified,packaged, <br /> ma Aced and labekdlplaurded.and are In all respeds in VOW Owdd n br eansporl accordotg to appicabie International and naomal <br /> goscrrrnndal ragvla6ont II eepan sltpmerg and I am the Pstrury <br /> Eaportct I rRrCFy Mat tho caNaaa of Ws 003s4"N wham b the Lerma of the attached FpAPdtwwledgrneN Of Consent.. <br /> I cerdly that dto waste rrinknlzadon Suarnont Alt:Med in 40 CFR 262,27(a)fd I am a large qumity gonefstoq or(b)rd I am a small quandtygemmla)Is In, <br /> GeneraloeVorraols PnkieCyped Name O Slgnahae Month Day Year <br /> OAT Aflow4w rr" e:R I�aRlalJeal 80MW Melq 4r O&Wor of 2N a Ffa� 9 /•Q <br /> .� 16.kkntadortat ShiprrteNs <br /> ❑brom to U.3. &,A flan U.S. Port of wrytwdl: <br /> Trwupoder.signature(ra exports oNy): Date kaovg U.S.: <br /> w 1T.TranspalerAdnoMedgmrf of Rae*of Malmials <br /> TransWer 1 PAnfedfTyped Name119 Month <br /> Day <br /> 9 i B <br /> transporter 2 P Wavyped Name Signakae _ AlonM <br /> 10,Discrepancy <br /> 18a.OccrepatryIMiationSpace D Quanity Type ❑Rasldw ❑PanelRe)ecdon ❑Full Rejection <br /> Manifest Relermtca Manber. <br /> 1ab.Alkmate Featly(a Generz:ar) U.S.EPA ID Number <br /> FatW%Prone: <br /> I ac,Si wturo at Momste Fe ry(or Generabr) Monet Day Yea <br /> 19.Hazardous Waste Report Martagenieat rretrtod Codes(t.e.,00643 fm hazardous+isle beatmml,deposal,and recydag systems) <br /> 2. 3 <br /> 4. <br /> 20,Des�lI;mted Faatity Usner a 6 Operatar:Cercom of r6wP(of hazardous rnaterlafs covered by the rnarvles(exotpl as Med In Ite/m leaPMI9�1' <br /> EPA Fotm8T00-22(Hev,3O5)Prevlousedtionsare bbsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED) <br />