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07/23/2019 MON 13:29 FAX <br />i�i3tJ�-•i.' <br />Please prtnl or type. (Fom1 designed fn, use on elite (12 -pitch) typewriter.) <br />UN(FORM HA71(R000S 1 Oe v ralor ID Nthlr6or 2. <br />41(ASTEMANIFEST ('f;�! <br />5. Gcnemtafe Name and Making Addross <br />Q H: TEREX <br />261.@ LYCHIK 93. <br />+.� coner;dofaPlnne: S78Ciil,t)k i`G 9085 F ±1Ui7: <br />,^ VT2 <br />� vunwr vVI llpc: _a1 IfdF IdS(E l±1 G'i1'C�✓ rler 2 Company NamalCd Fac 14 NymC end Site Address <br />QPnb CUPD01 LLC HIN PEC VIR(I'VENTRbhite Rock Road <br />ax,e. R1 0 U.S. DDT VDs4lio0 (inthrd!tV Pr�rer SNpp4a3 t�hme, Hazard Glase, ID NUmber, <br />Peching Cxuup (0 any)) <br />�1 .0-RCRA iiA1F)reEUU5 NiTr, SOLE (L'(1kTPiCi1({liEL S0�5.) <br />M .r11i]U4(Ii E'R-rT bar DTRs <br />X002/OOC <br />FnrrnAnnmvarf f)A4RAIr, ^nKanno <br />3. E(nargenoy Resporu Phone 4. fdanlles( Tracking Number <br />;)W7) 00016 3115 DAT <br />lanerolo(s Si!a Addross (f different Than msdln9 address) <br />FF.RFY 11MITIM 1NC-, IM TOrA — 0o,T?)ii lei 5FRYI.; <br />255 L1'CUN96 ST. <br />IJ <br />U.S. EPA ID <br />10. Canfsfners <br />11.lpfal <br />12. Unit <br />No. <br />Typo <br />Quantity <br />WIA?b. <br />13- Was(u Codev <br />30 <br />511 <br />15. GENERATDR`SfOrrEROR'S CERTIFICATION; I ItareaydI&IM that the Carilonls of (Ids corrBlgnMCA( are Wy and gccuraluly dascrlbed above by gio proper clippinganmo, aril are Cl:r shied, packaged. <br />Marked and lebded�lacardsd, and are in nil respeols In proper mndlFon for trar*poA eccording to eppl!Gble lnfemnGonal and n9onal gwliwantaf rquiabons If caport ah!(xnmland t nrn rbe Pr1w1y <br />F)tportar, t Certify gWt the Wntenls of #1I . con9lgoruant eonfWIA fo (be Isnttk of the alloChod EPA &knaxAedUmanl of Cprr unt. <br />certify that the WaM10 m-Wrrizakn stelemunl idanblkd in 40 CFri 1E2.27(g) (II f em a Ump quanllty geuaralor) W (b) (f 1 e u a wsl quonWy ganefator) Is ITue, <br />Qerraratore7UUerorsPdnfad adNnmC $irnakre _ MoiYlh Dny Yee? <br />ship nta I/ 1; <br />f�I <br />77 7 <br />LJimportlbUs. ❑&wthnmU.S. Ndofenlry(exll' _ <br />Trom-pone, afyneturc Ibr sxpofts enly): Daly - <br />17: T wiaporter Aclurowtedylne fi of RPcaipl e f 7huLrlaR <br />fralu�porter 1 Printedfi}Twd Nenre <br />y�� ^9r' hue Monlq Day Year <br />SEt?r-- U VI- �n� I ail �' t ! I,1-71 17 <br />IS. nlsmpericy <br />18a, Ufserepancy Iii(ficaban Space <br />u Quanfi(Y ❑Type ❑Res!tlue <br />Manite� Reference Nur <br />1Bb, Ahcmele FaUftty (a: Eicneralor) <br />J <br />U <br />Fadiiy'a Phonc- <br />w 18c. SignalWu ofAllenla!sr FaAity(ar Gelioratol) <br />s✓ <br />d <br />z <br />y19. Hazardous Waste Report A(anngumenf M,ugmd (,biles Q.e., codex (Of Hazardous waste 1t Lmanl, dsposef, Wvl recyding syslEma) <br />W 3. <br />1� <br />ADd H'atil ty oenler er p(uralor. Cefligcal on of receipt e! tazanfu� malepukd Uy the sl exrg as nrtod in Mm 190 <br />Narne uu2 (Rev,:fd)5) Pfevious editions are obsolete. DESlG ATE all <br />❑ Parks! heieceon <br />U.S. EPA ID Number <br />Dav <br />11 Ful f0jetbor. <br />(1F REQUIREDI <br />