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2012-03-21 15:46 5801 TRU 2094662259 �.
<br />I
<br />Ploaso print or typo, (Form nr
<br />dell rwd for use on elite 12•pitch t owdler,) i `
<br />UNIFORM HAZARDOUS 1. Gonorator ID Number 2. Pogo 1 of 3, Emorgoncy Reeponso Phona 4,
<br />WASTE MANIFEST C �, L C )j a) T .? "j ;4' � ? uGU aJ.4 F130C1 C I iChTiTtl�:
<br />5, Gorwro?,Numn oDC(1pNlnq+Wdroea Goneratora Slto Address (If diHoronl Ihnn malty
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<br />Gonoralors Phone:
<br />e, Transporter 1 Company Namo FRCIv1C)U1'b' V14VIRONI+AENTAL .ERVIClIw ll"r,:. Fillono l; !)U11 d> iso -3 � 14 U.S.
<br />7, Tronsponor 2 Company Name 71 Of CENTURY ENVIRONMENTAL kiAj A 1f:MF NT or 14E VAE)A, LLC U.S,
<br />6, Designated r•'acillty Name and Site Addroen 21 ST rL;E1`rrl,JRy E7v1! U,S,
<br />2095 Nf W1.ANpti ORIVE , LA-r.I
<br />r• EfRr4,C:Y, nry A9-106
<br />77."i -575•,x, rl.9Q
<br />5adhl 'n Phone;
<br />9,1. 9b, U.S, DOT Doacripdon (Including Propor Snlpft Namo, Hazard Clow. ID Number,
<br />HM and Pocking Group (If any))
<br />1. I'ur m" ti, ,0,a t)✓a v .w!. r, ar lilt tJiy "aurr.;-r
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<br />2094640138 P 4/8
<br />Form Approved. OMB No, 2050.0038
<br />it TMxO. Number JJ K K�
<br />" I. �
<br />C-ARGIA)1'i 11;117
<br />ID Number
<br />C;AR00011140 Q
<br />ID Number
<br />i4Vfl�1;r.'?L1£+5:13},1
<br />10, Containers 11. TOtol 12. Unit
<br />No. Typo Quantity W(JVDI, 13, waste Codoe
<br />+i 7
<br />1i,ind: etl,: to be 40hr tmined rind trm f:lPr.
<br />4)b1)386168-00 fti•;r,.,;-�FRO ff171
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<br />15, GENERATOR'SIOFFEROR'S CERTIFICATION: I horoby declare that the cOntonts of ihls consignment aro fully and accurately daecribed abovo by 1110 proper ahipping name, and art elbaelliod, packaged,
<br />marked and labolod/placardod, and are In all rospeela In proper condition for ban5port according to applicable Intematlonal
<br />and notional govammontnl roguki lona, If export ahlpmenl
<br />Exportor, I cortlly that the C01110rtfe of this c 191Intonl conform to the roans of the nttndtod EPAAtknowladgmont of Consent.
<br />and I am the Primary
<br />I certify that the waeto minlmblilon alalomenl Identified in 40 CFR 262,27(a) (If I am a largo quarnity getwrater) or (b) (H I amw email quantity gonarolor) Ig true,
<br />Generator Offoroft Pt ntodltypod Name S Uro
<br />1f _ t .. .- ^. _
<br />Month On Your
<br />.,
<br />16, International Shipments
<br />Import to U.S- Q Export from U,S, %r i Port of oniryloxlt.'
<br />Transporter algnaturo (for exports only); ( ( Delo leaving U,S,;
<br />17.TmneporicrAcknowledgmont0RocolptofWtomb � f
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<br />Tranaponor 1 PnntoorfypotlNa '"' S faro
<br />,�
<br />Month Day YOaf
<br />Tron5ponar2Hrintod IypedNOlnd J 51datum
<br />B,
<br />Month Day Yoar
<br />16, Di=opdncy
<br />18a. Olocrepaney Indication Space quantlly �) Typo Q Residue LJ PartialRojoceon
<br />U Full Rejection
<br />Mnnlfnst Rnfnmricn NUmbtn
<br />18b. Almrnme Facility (or Gonorator)
<br />U,S, EPA ID Number
<br />v
<br />Faellhye Phone;
<br />r-
<br />160, Signataro olAltomnlo acUlly (orGonoralar)
<br />Month Ony Yaar
<br />W19.
<br />Hazardous Waste ROOM Management Method Codes (I.e., codea for hazardous waste treatment, dispoeol, and rocycling syatcma)
<br />1,
<br />20. Doslgnated Facility Owner or Operator. Cortlficatlon of rdcolpt of tmzordoue malohols covorod by tho manlfost excopt as nctod In tlom 18a
<br />Prmlodfrypod Noma Signature I � rq
<br />�1�r 1 4:' '-r._. ' S G; �}•��
<br />Month uay year
<br />.[�:1,•r � 1" ,, •� • 1- � f,.t V 1"�" • . `'.
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<br />PA Form 8700-22 (Rev, 3.05) previous editions are obeoloto, O DESIGNATED FACILITY TO GENERATOR
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