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Please print or type.(Form designed for use on Plitq(12- itch)4pewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.&neratorll)Numl, <br /> 3-Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEE 1--!76 0 ()00'14F';7Qj SKS <br /> 5-G€nefatOrB Name and HalingAddressGenerator's Sile Address(f different than mailing address) <br /> 4.,.1 Ft,. Kc. <br /> Generster'sPhorie: 'Ill 1b <br /> 6.TraTpgqqr;1CpmK ""sys N U.S,EPA ID Number fn. <br /> 7.Trarnpofler 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site AddlessZ, U,3,EPA ID Number--X"Wi SVVEAS, INC. <br /> G53TH 1M.,FFT <br /> $ <br /> -FacNi es Phone: <br /> 9a, 9b,U.S.DOT DescHplion(indading Proper Shipping Name,Hazard Class,ID Num*, 10.Containers. 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WL%I. 13,Waste Godes <br /> f'. N'l i'F IRE U4 T E D M A T 5 R I AL. 3 r U N 1.Z 6 <br /> PA Z�1.Y fUUA TED tfATE R .6)- 3 UN I ZU,�j P"X;11? 0 16 1 <br /> 3. <br /> a. <br /> 14.SpeoislHandrmgtnSWClionSandAeeitionallnfofmalion *M','OT70Y34: OW. <br /> EMITt' "VZAR <br /> '14B��JERS AS NEXF- , Y <br /> 15. GENERATQRV0FRR0R'$CERTIFICATION: I hereby dedare 1hat to contents of this ron5ignmemnire fully and somffaWy d4"bed above by IN Proper shipping name,and are cismAed,padLaged, <br /> marked and laboIL&placarclLd,and are In all mspet[S in proper condition for transport according to applicable internaliorial and national governmental regulations.li[expol shipment and I am the Primary <br /> Exporter,I cctfy ilial the obnterits;of this consignment conform to the L-7ms of the attached 11PAAcknovAedgmeni of Consent <br /> I corlily that the waste minimization statement identified in 40 CFR 202,27(a)(if I am 3 large quantity generator)or(b)CK I am <br /> m a small quantity gVY60)is INC, <br /> GeneralciftrCiferors.Prfniogryped Name Sigrtaih" Month Day Yaar <br /> + <br /> "A5 ep <br /> 16.Wernational Shripments <br /> F-1 Import to U.S. ❑EVcut U.$. PO 11,01',e n I fy1a idt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LW17.TransporterAckriowiedgment of Reogipt of Mallerials <br /> U <br /> Transeqe&I I'dritedlTyped Napws aweMonth Day Yaw <br /> Transporl&2 PrintedfrypeciName" <br /> %gnaturai Month L Day Yea(' <br /> la Discrepancy <br /> 16aL D)screpgricy Indication Space ❑ Qu*ily OType ❑Residue El Partial kejea;on 0 Full Rejection <br /> Manifest Reference Nurnhrr <br /> f8b.Alternale Facility(or Generator) U.S.E RA ID Number <br /> L<'. Fatuity's Phang'. <br /> 0 <br /> LLI I 18C.Signature cl`Ntamale Facility(or Gsneralo* 11on11 lla, '1,-,r <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> 2. 4. <br /> Ra <br /> 2p.De�gnated lily Owner of Operator,CertilicaWn of recap!of hazardous malerialz covered by the manifal except as noted in hem 18a <br /> sigplp on, Day Year <br />