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UNIFFRM- HAZARDOUS <br /> W SLEE NANff EST Pev:cn Fom App ove <br /> sa pbno tMonlM1s,in:yn ONB No 3e50pn1y <br /> (D all Ic "Q JJK <br /> conu, s 6 <br /> I <br /> CD _ -_ ., esElr'Drunp., <br /> US EIAION p <br /> N uJ _ cTbl r <br /> US.EPA Ipy 0 <br /> �Y\ 'n(n[f�drq F'mp>r SMpp�ng Name.Hanrtl Paas IU NI <br /> th/ In Conhmee ,I inial `�J <br /> II Urn <br /> T NO iYPo OuanulY WI NOI O Mazlp Ccoo, k <br /> It <br /> N ral <br /> C- <br /> C- <br /> 0 O u s;ebalnaneingfnawd,a,lam„lambonal mfonna:e: - ., <br /> l/, 15. GENER4TOR SIOFFERORSCERTIFICATION Ih, bYeclare lM1al he contents In 'g 1 re111 tl mlel tl <br /> (D T - 1 y armbad above by Ne pulp al e,alV Iarri package0 <br /> `u fI IXetl endetradPl tlSgd areln III esp 0 parwntlbon brinnspoel od g, PPI' bl t nalanb nafonalgevemmenNl regul,b .If ponsnipmenl bla Ibe Pnma O <br /> Exroder.I ceety Nat Ne mnlenls olthls wwgnmenl contam lP the lertns of Vle anachetl EPA Acknq,abeg antofG nsent R` <br /> Q I,xNty mauve waste mrnlmizebon statement idenfilled in 40 CFR 262.27(a)('I am a large quanny generator)or(b)Pfl am a small quantlygenerelor is true <br /> —” ��. G fors'OnerPPSP�d/Iypee Name si Yxe' - �yE , - <br /> O 161nlemallonal5hipmenl5 <br /> F ❑Impact to U.S. ❑Expod fr..UG. Pow l ^ <br /> Transporter signabre(for expods only) Dale leaveaviningg S U.S.: Y1 <br /> r+ tI Traospoder Acmowledgmentof Recelylof Malenals <br /> Tran /r,pan(d,yped Name Figurine ,. M �I <br /> (D Lamsportr 2 PnnledRyped Name 1 Signawr�� / M- <br /> 19 Discrepancy r <br /> 19a Disrrepancylndlealmn Space ❑ ly Ll Trial, ❑Resitlue ❑Padial Rejection <br /> 3L <br /> r+ <br /> Manile9 ReferenreNumher T <br /> US.EPAID Namher ..J <br /> 190.Allemate Facility go torwill o �waS <br /> U , and c� O <br /> ra. Facaly'a Phone Ow Is s 1pping• Month Day <br /> ILL) <br /> 19c.Sig,all ofAllemale Fall h eneratoQ <br /> O <br /> 0 Qi <br /> ^^ l <br /> 19 Haeardous WaM.Repori MOnagea lMalhod Cides(I was ar hazardous waste bealmenl.disposal. ad reryding systems) 4 <br /> N <br /> O n of receipt olnMonty ay <br /> 20,Designated Fatility 4xneror Operaloc CeNfiglioazardgus malenals covered by the manilresNettepl a;ntledia Item l9a ( \ <br /> D <br /> 1 Print YWd me � <br /> N pESIGNATFp FACILITY TO GENEH <br /> EPA Fell 8700-22(Rev.3-05) Preylous al are obsolete. <br /> AUG 062014 - -- <br /> CD <br />