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UNIFORM HAZARDOUS ------ ,), •. - 4 Manifest Track,,g N:rn b=• <br /> WASTE MANIFES i <br /> e. "'a,- ll r a — <br /> __ s 5r'e Adlress I Ji .,l -'all e , <br /> P-Trr';Ol <br /> ,ns�•ne 2 Company Name <br /> Name,and Site Address ------------- <br /> F ac <br /> 9a 4!• J S JOT Cescr,p4on Iinclud ng Proper Snrpp rg Na ne Hazard Class.ID Numbe oda r,ers _ 11 T ; <br /> HfA ani Parpirg Group i f aHyl! Qu v, <br /> O <br /> H <br /> Q <br /> w — <br /> z <br /> W — <br /> I <br /> I <br /> EGENERATORIOFFEROR'S CERTIFICATION: I hereby declare tra >rgnmeni are ed'paca dcd and arena csPe u n props cont o se-rr ng to app)ca:y that the contents of this ccns:gn e+ o^fc'm to the terms of t!,p attached EPA Acknowfe.•T-waste mirnmzatwn statement rder ..'i;. ' am a large quantity genera'. err 3 ^ar a..r'tPnntedTyped Name S,gnapr <br /> J !emat, . L J Eaport from U S <br /> ? iransportersgna.�relFxe�po'L' — --- - ------ <br /> _. <br /> tY <br /> qZ Transportf r 2 Pnn!ed y"red Nark <br /> Cn <br /> 18 Discrepancy 11 <br /> 18a Discrepancy Indication Space ❑ Quantity Type �J Residue I�a•1•;!.ne,rJ.,_' - <br /> Manifest Reference Number <br /> > 18b Alternate Facility for Generator) U S EDA In N" ,b••r <br /> H <br /> J <br /> U <br /> uQFacdrry's Phone <br /> UM 18c Signature of Alternate Facihry for Generator) <br /> !R <br /> t7jj� <br /> azardous Waste Report Management McMod Codes p.e.,codes for hazardous waste treatment,disposal,and recycing sys:e3 <br /> gri lrtYorOperator Certification of receipt of hazardous malenals covered by the manifest except as noted to Item 18a <br /> 'rued NamergnaNre <br /> Formt17,J r^ <br /> ".Rev 12-17) Previouseddlonsareobsolete GENERATOR 5 INITIAL` ="' <br />