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W---k lotff 886297 72678 <br /> Please print or �(F=desi ned for use on elite(12-pitch titer. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1'GMemtor lD Nbrtber 2 Page t of 3.Emergan y Response Phone 4. en TreoMng Umbar <br /> WASTE MANIFEST 71 5 0 4948489 JJ K <br /> 5,Gmerabrs Name aM Mae"Addmse NIS Generators SNa 0a mss(NdlBelmd man mela+g address) <br /> HINK 09POT C/o 3E COBPAIT 9018 OBIOT 19115576 <br /> 1415 A350i AIME 1111 711 VA1CT UMAY <br /> canaralAi1R11A9 CA 42111 111 €51-831fi LA OPCA 25331 (311851-5513 <br /> B.Transpolar 1 Cen mny Name U.S.EPAID NW Wr <br /> 21st (W`l1RY MMUOREWTAL HN1thG1EHM4T CNNM164012 <br /> 7.lransportar2Com try Name U.S.EPAIDNumber <br /> S1_ <br /> L , e�JorDZQUUoD 7 76' <br /> B.Designated Fsdkty Hann Ad SNB Mclean U.S.EPA 0 NWbw <br /> 90ILIIOT01 UnUMRAL, LLC. 1881 FACILITY <br /> 21245 7759 AV= MM <br /> Fedg aPhm,a: U f, IA 48132 (253) 172-1131 WAD991281767 <br /> gb.US.DWDnof ®n nd,tl PMWSNppin Name.Haaam Cless.IDNuTkWt 10.Comelnem Ii.Total 12.UM <br /> 8a. and PadN,g Om"(tlany)) No. Type Quansty WtNd. 73.Warne Cotler <br /> HM <br /> �g5 t. . . �I <br /> ar 2. 111263 IAST9 FAIR? HUM IASEIIAL 3 FOII 1Q(0111-1111 T D1/1 0135 331 <br /> cn ®a� -m- C1ya0 P <br /> 3. p <br /> x <br /> 4 013266 11858 Coll sm L quo, 9A8IC, IIOIOABIC, I.O.S. (So0I81 9112 122 <br /> 8 ml0EII18, Po4A81I919Y01O1IO8) 1 PITI 1Q(0112=111( OP1( -611-• 0090 P <br /> te.Spedal Handling tnundoos and AddEonal Information 9_)'j-k957' 0 <br /> [+FR ®1 _ vae(„eS a.e:,arnA(2) U-13 - UG(121) I111111BLE L003EPACl rf <br /> (L'+Q+71w"'-w.4) (1) EI®1Y-14 - =1158).ALIALISEi-°mean„�ss4l,Lplmg3AA1: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:Ihembydedam lhm Memnrems oldds ooroipnmenlemNB/aM 6aumbrydanoibed above WNe papm shippin9 nance,am em daasihetl,perYaged, <br /> marled andlabaledlplaramad,and are in all mgecb in pmPer oor,N6an for eanapodacomelog to apdicablelmama9mmland natiwatgovernmental reg dammS If export ehipmemaod I am ma Primary <br /> Exporter,I perhfythg lhe=wts mlhis cwNgnmentmfwm togm time of lheabed,ed EPAAdu,*Medgmenf of Consent. <br /> I mrgy 8re1 Ue waele minlmhabm slelemam i&tffed In 40 CFR26227(a)pf i am a"gua*gweraw w tb)[di am a sme9 quantity generelar)a We. <br /> slOBerms NintedRyped Name Month Day Year <br /> Lop 111 a( <br /> 16.Imamadonel SopwoutL1 <br /> Impart to G.S. Exportfmm U.S. PatdM <br /> Transporter s%mtum(for expoda am/): Dale leMnaU .: <br /> 17.TrmwponerA&noeMdritatof Receipt of Matadels <br /> Tmnspodar I PnntodRyped Name re Momh Day Year <br /> ki 110 lot Id'? <br /> Tmmpalm t N me Siglmhrs Man Day Year <br /> .,..ra. <br /> 18.D'eaaWncy <br /> 188.Oscrepamy lndiraeo Space '❑ Duandty ❑Type ❑Raeldue El Partial Raledbn ❑FUNRajecYan <br /> Mendaal Referwte Numher. <br /> 18b.Alternate FadIgy(m Genaralol) U S.EPAIO Number <br /> U <br /> u Facdays Phone: <br /> 18c.Signature ofAllemma Facility(or Gorwalor) Month Day Year <br /> 19.Hamfdoae WmW RsPmt Ma,mgemW N6dK a Cod@$(it.,codes or hxaardouswasre baftn1w4 disposal,3M mgrmg syslams) <br /> 01, 2. 3. M1. <br /> 2P.Dealimmad Famlity Omw orOpemfor.Cwgkdm of receiptcl hmardous matsda w"Ad by he mmi/esl except es mdedln limn 183 <br /> n Name signature Month Day Yawl <br /> v 1 to it <br /> EPA Fom 8700-22(Rev.3-05) Pevious'sacns are obeolel . DESIGNATED FACILITY DESTINATION STATE(IF REQUIRED) <br />