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rwn�w:�,Ww:Dr,v.. ...wvw.,.5. ,.. ",.�',.y *-�`-ia..r`r:�.:.�• <br /> PI9.pse priM or type. FgrM ' nsd•fofcuga on elite 12• l(Ch)typewriter,) IF=Approved.OMB too,ZO�A•A039 <br /> PN1FORM HAZARDOUS]'i.Genarefar ID Number 2.Page 1 of 3.Emergency-Res Phone 4.AWIlest Tracking NufnWr I� p <br /> WASTE`MANIF:e TLOGO 75 ` 0 0,U 2,6-0 7'4 Z G B F <br /> 5.(General or'ss{Na{{m]�@((�A{f4y MailingAddrsss,-' Genafalora i dregs itfcronl than mailing address) <br /> "PTrdnspgder 1 rampany Name ►� �. IlasVumbpr <br /> . ,f US A 1 * <br /> 7,TAN <br /> ransporter 2 Compairy <br /> NAM <br /> _ ; F,pf11O Number, :F <br /> 8.Designated Facility Name aro SiiteAddress'. Number <br /> y0'i <br /> 9a• fib.U.S.DOT "e'$ iR On(... Ong Proper$hipping Nine,Hazard pass,IDNunber, _ 10.Containers 11.Total F12.UnitHM and P{cldng Group(i Na. T)pe Quantity AJVoI. 19.Waste Codes <br /> 14011.410RA HaZardou9 waste, sokflf- " ? <br /> 2. <br /> u.r <br /> "r <br /> 3 . ..... " CERTIFICATE.' T <br /> OF R-ENC31-INC <br /> 14;Special Handlk,�g Insimctions and Additional'Informallort <br /> it r.�r. rct�u ivy Uflthina ;a+zd,E-Varner, 9.°i •C?#k..`>r F BSORMT E'R-0_-9.1 *17i <br /> 15. GENERATOR'SIOFFEROR'S CERTIMCATION: I hereby declare that the contents of this consignment are fully and accurately described shove by the proper shipping oar",and Ara dssslfled,package0, <br /> marked and labeled/placarded,and are in all respaots In proper-condition fru transport according to applicable international and nallonal governmental regulations,If oxtrdd shipment and I am the primary <br /> Exporter.I cerlity that the contents of this consignment oonfonn to the ternfs of the attached EPAApknowlsdgT enl of Consent. <br /> I certify that the waste fflWmRation statement idenfified In 40 CFR 262.27(a)(if t am a large quantity generator)or{b){If I am s small quantity generator)ig true. <br /> G.enerelgr'slO%rot's PpinieMyped Name Sigrrehse Month Day Year <br /> J116.Intemelionel Shipmanls ' <br /> Z ❑Import to U.S, ❑Expert from U.S, Pori of enlrylexil: <br /> Transporter agpalure(for exports only): pale IeaNng U.S.: <br /> 17.Trenapool tACkniMedgmenforReoeiploftiM9iarlels <br /> Transporter 1 Prtntedrfyped Name Signature <br /> Month Day Year <br /> r�jy u°7 eP� C 4_ "y <br /> Transporter 2 Pdntedlf ped•Name i f <br /> Si mature Month ay 'Year <br /> 18.Discrepancy <br /> i <br /> iea.Diacrepancy Indicelion Space ❑ ff'�puanlity LJ Type ❑Residue ❑Pargal Rejectlon ❑Full Refection <br /> l ab.Allemate Fadlity(or Genaratar) Manliest Raterence fJumber: <br /> U.S.EPA 11)Number <br /> U <br /> LL FaciAtys Phone: <br /> fou 18C.Signature of Alternate Faedity,(of Generator) <br /> xMonth Day Year <br /> 19.Hazardous Waste Report Managameni Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C3 1: a 2. <br /> 3,. 4 <br /> 20.Designated Fa€illly;OWter er OPora14r:Certification of receipt of hazardous materials covered by fha manifest ee as Acted' tem <br /> C Month ay Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are ObS61810. <br /> 'd 9650 'AN ,.. I WdlZ : 11800 ,des <br />