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P;edse <br /> print pr type. <br /> UN�DRM <br /> i c ASTE M�ES�Us 1 �neramr tD Nu <br /> nerafo s N ether <br /> eandf,�ai" CALO <br /> bEi 9Ad J�3 2.iage 10, 3.Eme <br /> 8A 'Srt� AR� PALLING rgen'r onsePh <br /> Genera c'e h G1Fl�RL� pal�E 451•l 4:ManifestTratkino� proved.OMB No,20 <br /> 6. S Phone: CA=�81 Ga of to O 9 NuQm r 003v <br /> Ti�r'S ato's Si Arklress d ddreren. 6 V �l <br /> Aorter 1 Com tha, grin L J K 4 <br /> ' 1 {P�anykaI N-1r) i 7 ��,,,�qEE Rp 9adiress) <br /> 7.Tr3r+apo{,rlOpy y TrF�{��1��I S4I � A <br /> k��� YName tdt7t?fiS, It1C <br /> 8.UesignaledFaCoi aM� f��jtV- 1�.4?5��- �� U.S.EPAIDN�mher <br /> ry Name end Site Address SERVICE ! <br /> I-H)GHWAY M1Kgg37 <br /> g3 UES aU�- (S1Ct)749-413g s.ErA Io Nun�r <br /> Fa cib $ADr SEg7ZA, 1NC CAROCI4(k?p 4 <br /> 1Ys Phone; <br /> (: IO ).239_39 3 U.S.EPAiD N rtxr <br /> 9a. 9b.U.S_00T3 NV � <br /> H1vl and Pa �s�Ftior(ir,Uu�ng Propel Shi <br /> ddng Gmu�PAlifFa�y)1 pl Name,Haza d Class,1p <br /> h 1 �Ni�,'rr+�5e, /4E Number, <br /> �B5oj5, ta�rers <br /> 21. ERG126 10.Con 1,Toa1 <br /> No TYGe Quanny JRNOI, t 11 Waste Codes <br /> LAi <br /> x z. U6G, 1 of <br /> 21 p 01 DII <br /> (Sodium }� � �°�°�E }Duff;,basic irwrganic,n.o.s. <br /> Ytrvxiefe,ar>nmaflia <br /> ) 8, PGii.F-RG 41�4 1 <br /> X 3. U>W1�1,.Waste DP 29 p 122 <br /> r1 1 G la11t£SajutRoI7s. 13 �'Gjl,EFtG <br /> ,r <br /> 1 1" Non-RGRA H 0P 21 02 141 <br /> P <br /> Rratf>JcL�) Hazardous�Nasie, liquid (C�vnsul <br /> 1 1�a pr 1 <br /> id.Sperlal Handfn8 fr>strtr ons andAdditonai Infcrma;ion <br /> SG'LfDS 3_RL <br /> 1.RL>iWO11 RLNIP101• ROSOLS 2 RLNIng4F RLHL444-CCRROSfitE B IC L1QUffts& <br /> 1 Ntll?�B/RLH dB-BLEAC}{ q RLt1NVdt?i I RLNj.�y,-NaN4 4AZARDOLIS L10UIDS&SOLIDS iT:i419.2 SIC LI2 <br /> 1 <br /> 15. GENERATOR'S OfFEROR'S CERTiFICAT!(}N: Thereby dedarg tt of the conte,nis ci thCs consignment are fully and acarra ely desWbed;ooue >he <br /> marked and latrzJed(placarJ£d,aid are in all resp:ots in proper avldiJon for transportacoordhg W applicable irtemat onal and naional geverrmertal regula4ans II <br /> Evorte;,I cctf/that the M llPntS Of this consicnment conform to the terms of the att�hed EPA�knowkldgmete of Co sent. � pnper shipping nave,a are dassified,7k;ged,. <br /> I cer5fy that the waste minimization statement iderl in 40 CFR 262.2T(a;in I am a large u F s i i and I am rFa prima y <br /> Generalct`aoferoles Prince g q Y gene r or(b);if+am a smal qua try generator)is"e. LO <br /> PHIL P Name s gna <br /> b1ARC1E1' �3C � � n e uroR L Mont oar Year <br /> r �M�— G9 30 25 <br /> � 16.inlema8onal Shi}�tents i�t <br /> t`- 0 Impart to U.S. ❑F ort fnor U.S. Pro of enby'exit <br /> Z Trarsporterslgnature{for exports only); Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Reci of materials <br /> a Trans r Pr ntedlTyped Name goal r Mont Day Year <br /> t ! iQ�1 Cl <br /> 09 W zs <br /> T n er2PrintedfTypedName atu Month Day veer <br /> to I. <br /> 18.Discrepancy r—� <br /> I ea.Discrepancy Inl Space Qua rtkj ❑Type _!Residue ❑Partial Rejection ❑Rill Rejtctan <br /> f <br /> t MarntestRefererla:Number. <br /> U.S.EPAiO Number <br /> 1 Bb.Aftemare Facility(or Generator) <br /> J <br /> Q Faalityls Ptane: Monet Day tzar <br /> C) 18c.bignafure of Allernato Faality(or Generator) <br /> r <br /> dis sal and reirding systar l, <br /> '' rent 1�ielttod Codes(f.e.,Lodes for nazardous waste treatment, po a. <br /> � 19_Hazardous Waste Replxt•"Manage 3, <br /> 2- H03g <br /> �. H039 <br /> NII fl e <br /> ct haYzrdous mate iafs covered by the mirl except nded I-,1I lea <br /> X.j)esignated Faclity Oyrner or Operator.Certifi an Da <br /> on of ter eiP w <br /> ?nnlcxllTYDed are 111 <br /> � DESIGNATED FACILITY TO EPA'S t}NlA�1lFEST SYSTEM <br /> EPA Fcm;870a22(Rev. 12-17) rrevious editions are obsolete. <br />