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=.b3ss raerl of Ivp, (Foran designed far use on elite (12�Ndch, typewriter) Form.ADPRNRd: OMB No. 2050.0038 <br />EFA Pomp 570(-22 ll 3-05) PreVOW ud¢Ions are (nsaele. <br />UNIFORlO <br />2.Pagoiof <br />3. enegsncyRe...poan <br />4. ManastTack ng Nre ber <br />'HAZARDED <br />WASTE MANIFEST <br />JJKiGtoD <br />05478 <br />, ,' <br />rM <br />3" <br />J "neramra thine ane Madera Address Geraniums Sit. Addrafis of dlflJ[gnl than missing address) <br />1 a Prone: .. ...r} <br />C . TrensPY,ier i company Nzma U.S. EPA ID Number <br />7 -wp parer 2 Company frame U S EPA!) Narrow <br />' <br />> g atad lxcLdy Yame spot Ste Address U.S. EPA ID Number <br />c ,a P,ane. ' <br />a, <br />"k. J . OUTDesalgr0an QndcCaug ProperStnpp,ng Name, Hazard Gass. ID Number, <br />10 C.^Narrere <br />11 Total <br />12,Unt <br />13. Warner Codes <br />No. <br />Type <br />!gJ <br />andac <br />Pt ng Group If any)) <br />GuarHty <br />ird . <br />Vid <br />F- <br />;:.. <br />LU <br />Z <br />to <br />l r Rm, <br />4, <br />.. <br />14. n'pedal tiarxlting 5tsrrarf+ons an'Addipwal Ntdrtragon <br />v <br />15. GENERATOR'SJOFFEROR'S CERTIFICATION; Irural ceckrari,,o contents oitns Loregnmem ars fully an, anwrway,aescdbed above by me proper ahippir+g name, aN we dowel W, packaged. <br />marked and Iabetediptaveded, and are to all reapaets in pmrser eonGdan fa marl according to appfiwix irematlonatantl naruoal govt nmelme regula6ena. If export sIllarl and I am toe FrMory <br />;--XDOW' Icnrofy rfrat ane unt&ntsofP+s wasignmert uanhunr b NS Wrms of fat Worse EPAAMurrokedgmea of Consent. <br />.ory!'Ld 1 a waste ewer ipaUrn statement idem ted 1n 40 CFR 26217A) Of l am a large gaanuty gmrepmod ar tot (iH am a small quantity generator) is "a <br />e adµ:Lv:mt, P lr2ed hbnto 1 'µ l Month Day rear <br />,x r <br />J <br />a n (St ai Ssl^.I'IbnS <br />L�{iropon [o gS. �Expol from US, Port of e^uyrextlr _.__---- _....__. <br />F-. <br />2 <br />TrwFoun sn)pa4se for 0Kaure,Cn'y). Date boving D.S'. <br />t G¢I p;tterAcknowledglrnnt of RecMptof Materials <br />LU <br />C . Pflnlridflypeg.Nama Signature Mcnth Day Yea, <br />LJnaPO" <br />- f Month Day Year <br />ra zrorLr2 Pnn(d YO'd M1cnx Signam e <br />*t <br />C <br />H <br />_ <br />d D c r ,ncy <br />IllDiscrepancy tral,cyaon Space 0 -type DFredje ❑Partial Reec6m Ful: Refection <br />QpA-Ldy <br />Manifest Refarence Nurdrx <br />18b.Ni»mate Facility ,Or Generator) US EPA ID Numisr <br />U <br />tae- <br />=acNfs Frons. <br />W <br />Month Gay Yea• <br />1&. Sigsa'ure of Aae'naleFtilry for GanarslUQ <br />19. Hazardous Waete Racan Managamam Methrd GoCea(.e_mties for hazattAus waste vaatment. dl6posal,aM reeydino systems) <br />d. <br />0 Da •graded Fau4ry Own W+ e ^,Or en" Cedup auon cif renew of hazardous mstuiols covered by ma mer,ifastexoNd as nam in Item 18a <br />Mont, Day Yaw <br />I t ypad ams Sgynatwe <br />r_cnlc❑aTnGt'C IAdST1A4. Cf3PY <br />EFA Pomp 570(-22 ll 3-05) PreVOW ud¢Ions are (nsaele. <br />