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Form Approved.OMB No,20501-0039 <br /> please print or type.(Form designed for use on elite(11 2-pitch)typewriter,) �y R". Age PI)DI)a 4,M it i� -- <br /> :R-.�n;�PIWIA M6�I", C�n Tb <br /> age 101 3.::11 lo'ge n Y-1 SKS <br /> I U9IFnRWWRD0U IC! ID Number CARGO <br /> WASTE MANIFEST Generators Site Address(it different Inar mailing address) <br /> 5.Generators Name and Mailing Address <br /> DELIA TRX FA,ESP,03X 31270401)y 13 <br /> lole2 E,t3U'FH 01AM.Al;q R;j CA 952,-31 <br /> FRENCH <br /> p,rl <br /> Generators Phone: 7 U.S PA 11)Number R0 0 0150 <br /> & <br /> U.S.EPA ID Number <br /> Company Nares L <br /> S.Doignaled Facility Name and site Address -SA ETV—KLFVJ SYSTEMS) 11'4C, U.S.EPA IDNumber <br /> 60(do 89TH STREET <br /> 75e28 <br /> Facilil's Phone: "JV01,11 <br /> Containers ontainers .Total 12,Unit <br /> 9b.U.S.t)Drroesc6pwn(Including Proper Shipping Name,Hard Class,ID Number, No <br /> waste Codes <br /> 98. No Type Quantity —j -—,2 ,. —D-- - <br /> HM and Packing Group(if any)) ffo ,. "f <br /> XK I-UA$7'F Y IHT k LATED MATERIAL, On <br /> PG 21, 4ERB?#i28) ZVGAUF005-F0031 DO"' 1-2—14 <br /> LU <br /> 3. <br /> 4. <br /> 303 Z) <br /> 14.Special Handling Instructions a aWn 00003709 0 07 <br /> 511; AUTHORUED 70 RETAIN LjC;EWSQ SUNSFOUENT CARRIERS AS NECESSARY <br /> T5. GENEItATOR'S10IFFEIRCIR'S CERTIFICATION: I hereDy declare man the content&of this oDrisignm*ftl 2 1 re UIY and aocuraiely described above by ft proper shipping name,and are classified,packaged, <br /> marked and labeled/plaoarded,and are in all respects in proper condition for transport gCoording to applicable internationaland national governmental regulations.If export shipment and I am the NmsfY <br /> grimerd Qonform to(he temis of the attached EPAAcknowiedgment of Content, <br /> Exporter,I certify ftl the mrilOnts'Of this cons'� 7(3)(if lama large quantitygerierat0f)or )Pflamssma�il n9raitor)is true, <br /> I oerli�that the waste minimization allalemeril Idenlified in 40 CFR 262.2 S*at "an I q tenth Dey Year <br /> 'ifl'u—`rods75print <br /> ciffyped Naffle <br /> ........... <br /> "R P <br /> —1 6.international ShipmentsEl import to U.S, EJ apmr1rom us. pod 01 entryleyiI. <br /> pale kavng U.S.: <br /> Transporter signaltife(for exports only) <br /> 17.Transporter Acimowiedgrnerd of Receipt of Materials Month Day year <br /> Ll , Si WUTg_ <br /> TraPri tedTr'P edName <br /> Month Day Year <br /> ;E iyansporler 2 Printedf7yPed NO�Fe <br /> Signature <br /> < <br /> a: <br /> 18.Discrepancy <br /> 18a.Digcrepancy Indication Space ❑ Q"Iity El Type El Residue ❑NN,I R.jeclion ❑Full Rejection <br /> Manifest Reference Number; (1,8.EPA ID Number <br /> 16b.Xternale Facility(or Generator) <br /> L) <br /> 4 FaciliWs Phone; Win Day Year <br /> 0 1 Bc.signature of Alta (or Generator) <br /> LU <br /> sal.and recycling-,yslarns) <br /> is.Hjza*jiswaste RLpodM agemErdlvletbod Codes(i.e.,codes fvbszxdouEwa&trealmenl� 4. <br /> Do — <br /> 2. 3. <br /> H141 tz --- <br /> 20.Designated Facility Owner or OpLralor:Certification of receipt of hazardous materials severed by ft mardfast except as r�Hld in It=183 .,., - ----I <br /> Month--UTY Year <br /> FPnntedfTWed arne, <br /> 5f <br /> 899-9 ZZOISOOd 06Z—,L 916�98EKG 81:Z1 01 -SE-10 <br />