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HIJCiy2S-c' ( 1,5:96 From: Io:4bnt3oc � -+ <br /> .r <br /> Please prat or type (Farm Uf9191le0 for use on RIIM(72-pail) d1er.I Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS1'6e-neM'"b Nunber 2.PagA 1 n mNgmcy Response Muw a.M A I Tneaing umber <br /> WASTE MANIFEST '� ,,,,o ; : ..; -L... 6607��03$2579 FLE <br /> 5 anarnm s ane and Ma4rg Assess f m AOMIS bi d6rers WA n' address <br /> rsPbrle°la•Jv a`:TI.P %33 ':�� l.aQ' ., +�.1 <br /> ra kp' mpany Name U.S FPAA1Numlam <br /> 'rf.;q:i a .,9'_"`d0.ftfi'.l{'. '«_{- SE='S I=•:... ri:.,'j':-¢Yd,s'F <br /> / 1r..zVxIw rr"yNamo V9 EPAIDN~ <br /> 8 DesignNed FBUir7 NamsaM ba; Onss U S.CPAID Numlw <br /> Zr <br /> 43' <br /> Bn. 91,.U.S.DOT Ik Oiur(FriiMng Proper 5hippiN NIM,ttU4 Cl,,,ID Numyer 10 CmlSnnm 11.Tow 12 wok 15.Wacm Cooee <br /> NM V9 Pxamg CmM11 Nyn No Ty, Ouanbly W1Nd <br /> 0 t ; <br /> 2Al. <br /> A. I <br /> 14.=1 Namfe9 fie" 1plene and AddidonS Inlormaaon L 4=� {.. <br /> 15 GENERATOWSIMEROWS DERTWiCAmON: 1 hereby dedam mal the mnanm of ine:,visignmanl an My and aocuralay descet ed Nym by me'repar sri,ag nama,.aro aro cWaaNk.paek.gnd <br /> ERMml'd 111V Met!"WIL AS MW el ref'ebN in pfuper mndaan r'n b,nc;pud chart EPA to a.,>i le i na of c na;nT. n;r4mN govemmenlal rogublioru.d exl9�r=l:prgnA nntl t em dr.Pain,ry <br /> Egwler,rad(y tialma mnl9nts d me ConepnmeM gn>(alu W Vra Yrms d Vm agachao EM Arinrnrrybinam d Carueni. <br /> I rnrAfY dal me waeN ninimvaonn enmmfnl iUmMed in a0 C(R 182271ai(if I am o hurra;uuanyy genemlor}or(b)Ig I am a Usnn,auu,Bly gawnlor}N m1e. <br /> Gwerato9. stat rin nmr, „gn re Y yaw <br /> d 18 hdometionel SNvrNtnM <br /> !. ❑ImpOn tOU'u. ❑G%pall from U.S. P'nM,mlry%eaT. <br /> f M,.,s,A. .'flur bawls cnDem leaving U.5.' <br /> w 17 Trampan:rAtenewldgmem of Rereldfx Materiels <br /> Q T79WW l PANWvpgd Name swaturs <br /> raraxmrJ Name Signa ursMclean y year <br /> h <br /> 1 18 OicmpMry <br /> 18a.Discrepancy InUiudm Spew, n sAla,aly I❑Type <br /> LJ Resaw ❑Panwl Rry.rdgn ❑fup Nfquwur <br /> Matrluet RR*F..AM Nuns: <br /> I W Aa@mce Facet,la C. ern.un) tJ$ EPA ID Number <br /> U <br /> Q <br /> u• Facdn'9 Prone. <br /> H1Be.sgnawmer Mi:...uk Fauhlylcy,C, nTor) Month Day Yoa <br /> Q <br /> Z <br /> NA R:pardaw Ym w Repan Monagemerd Meava Curbs(i.e..masa far hnamoea warm unnvnMl,,e.'sv'u1.and meycfng syssame) <br /> 1 70 Deslgnew Faeley Owner of 00unlur CWLTraannd rAybfAVAfhQ20nlcuQ msteriah, red by ft mw fanl avaPlA ruu in Item Ise <br /> PdntedRyOed Namr ea" Lbnln Dar r„ai <br /> EPA Form 8700-22(Rev.}05) Pmvrous sditlom are obsolelc. GENERATOR'S INITIAL COPY <br />