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R{1��( I �/(/_ yam <br /> Please nM of e(/L1'or io t�Se on elite(12-pitch)typewriter.) r Form Approved.OMB No.2050-0039 <br /> P NP lF 9 I P I YPe. I PP <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page i of 3.Emergency Response Phone ,., 4.Manifest Trackin Number <br /> WASTE MANIFEST - - y0119 19 2 4 FLE <br /> 5.Generators Name and Mailing AddressGenerators Site Address(if different than mailing address) <br /> C 411 FaLN 14 l+6AL77-/ CAIZ6 f /C Iry <br /> 7707 SOEGrii AUSTIN R0. �AA: tivrimlY V) 77017 SUleThf -*"S)714 2/), <br /> SraCKT-Oi C4, 05;Ll5- SToCKrox" Go. 45'a(s <br /> Generators Phone: 010")- q <br /> 6.Transporter I Company Name U.S.EPA IO Number <br /> a l C C4 <br /> 7.IT erg ompan Name •.yU.S.EPA ID Number <br /> 3A L 03 <br /> 8 Designated lablity Name and Site Address U.S.EPA ID Number <br /> 12tic) CHEM <br /> q15- ISIS A116 <br /> ma"a6tyo5wPh�«i voor5f, G9. 9o301 _ - 3 <br /> ga 9b.U.S-DOT Description Including Proper Shipping Name,Hazard Class,ID Number, 10.Conwiners 11,Total 12.Un4 <br /> and Packing 13.Waste Codes <br /> n9 Group(if ani y)) No. Type Quantity Wt.Nd. <br /> N AS7& r7en u�, Glau , 7-0XIC, <br /> 0 N•01 S. esar 11UM #TJQ <br /> Pi Cl F 100 P311 <br /> w z UP(W-/, WASTE McioleWE/ C( K60, 17/Yf G/ <br /> Al.C,SIO <br /> c2 , CSLC6h'� sin-F�OEI/'9-C/t65GC�G, I/ <br /> 01 l t ! <br /> 3,C/N Yti 9, w/1 Sir /7Eb/C/NF SGu� YZ)[IG, At 0.Si <br /> C EVA JZ#i ii1rYt0G7CYC—Ai"ii r-41i 6-/I p4.aZ 001 <br /> t10F (A o 4 !tt <br /> . <br /> 14.Special Handling Instructions and Additional Information <br /> ji 4,P "bro/c/ e-1Gt(4f 0-A4" 7-5� 17(13378 <br /> 2�Ln MGp/e/Nt 1-1iVO 449awZ)IV5S <br /> rs>n-�—GG 17q 3348-00 <br /> a)�P nenlciNE SGG/U - ,01-W ��y �583b4-Or 3),11 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedam tha4the contents of this consignment are fully and accurately described above by the proper shipping name,arid are classified,packaged, <br /> marked and labeledplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.Ifexport shipment and I am the Primary xr_ <br /> Exporter,I cantly that the canters of this consignment conform to the earms of the attached EPAAcWowledgment of Consent F <br /> 1 certify that the waste minimization statement identified d 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(d I a sma true. <br /> GeneratoryOfferNS Printiad.nWedt�irtre.- igna re on ay ear" <br /> C-1 VS <br /> 4 <br /> J 16-Intemationa Shipments <br /> F ElImportb U.S. ❑F�pat from U.S. Port of entry/ex`' <br /> Transporters nature for exports orlDate lea' U.S.: <br /> WW 17.TmnspaterAdnovAedgment of Receipt of Matelots <br /> 1- fTyped Transporter 1 PrintedName ne Month Day Yeaw - <br /> z T in P edffyped Name ' ature ;, ` Monro ay Year <br /> 1p�497- <br /> 5 to 22 <br /> j18.Discrepancy <br /> 18a.Discrepancy Indicabon Space ❑ Quantity ❑Typeje <br /> ❑Residue ❑Partial Rejection Full Re ction <br /> Manifest Reference Number: <br /> r 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> a <br /> LL Facilit's Phone: <br /> w 18c.Signature of Alternate Facility(orGenerator) Monro Day .Year <br /> Z <br /> Z <br /> ce <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste moment,disposal,and recycling systems) <br /> I <br /> 20.Desig od Facility Owner a Operator ertifiration of receipt of hazardous maleffaliscokned by the manifest except as timed in Item 18a <br /> Pruritediffliped Name Signature m Da Year <br /> P <br /> EPA F rm 8170b-22(Rev.3 01 Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATIONSTABvIF REQUIRED) <br />