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Please print or type.(Form designed for use on elite(12-pitch)typewriler.) Fort Approved.OMB No.2050-0038 <br /> ( <br /> UNIFORM HAZARDOUS 1.Generate ID Number 2.Pago1of 3.Emergency Response Phone 4.Manifest TwItIn Numbeer� <br /> WASTE MANIFEST `.,x: ('i tt t}tj } tr _� t,ti�tf„'_; 9.100 O Q O 6 JJK <br /> 5.GeneraE9es Na"and hl#.N Address Gerseratoes Silo Address(if dNerenl than ma�rtg address) <br /> �,.`.•r ra ,.,iL:"'F {1,3, 1 A ns) >7 <br /> GeneratoesPhone: <br /> 6.Transporter l Company Name. U.S.EPA fDNumber <br /> I. BURY ENV' !,0 NA to it fAL i 7 ill C A D 0 7 � (0 <br /> 7.Transporter Company Name U.S.EPA iD Numberr <br /> 8.DoVgoated Feaaty Name and Site Address U.S.EPA 10 Number <br /> l/�;t y <br /> Feat lie:s PhonA t�' 13 <br /> ga 9b.U.S.DOT Oewu tion(indud?tg Proper St.Wq Name,Hazard Class.10 Number, 10.Contalrters 11.TOW 12.Unit 13,Waste Codes <br /> HM awPacidsgGroup(if any)) No. Type Quantity Vlt V- <br /> 1 _; _ <br /> ;oft , ,art..,, �{ } �;1,=AS€E,I IOUID A ,�_. ; <br /> ' <br /> D <br /> 2. <br /> JUL 9 7 N17 <br /> l.. . . I .,..._. _. <br /> a. <br /> ENVIRONMENTAL HEALTH i <br /> NT i i <br /> 4 L <br /> i4 SpeuallfandnglnslNtt"ortsarMAddtonallnformaton <br /> . 'AA, OK-1.00W.", I.ts{"c. � t:'!t 4.11�Iji�r. .t:'r'i,1'r::..(_r: {. �}r3-A <br /> ."ll;i'.. t;r}it !.111-Lt ,ia t f- L (tt �('�:."r _,..^ i ,313 rt Ali j <br /> AI i. `All :3)=.2L1 i'k,r._.(}s . )._)._..(i„._ >).;. :Ire.' <br /> �f103 <br /> 15. GEIIERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare Thal the contents of this cams gnment aro hrey and aauraleydeschbedabove by the proper shi p4 name,and are classified•packaged, <br /> manned and labOed'p acarded,and are fn al rospetts n proper cond',ton for Vansport auadrng to aW-,'c a international and national gatnntenlat regulations.ll export st pmenl and t ant the Primary <br /> Exporter,I certiiythal the contens of this constgnmeN conform to the leans of the attached EPAAcgwaiedgnlent of Convent <br /> I certify thaltho wsto minlrtw4on statement iden8fied in 40 CFR 262.27(x)(ill am a large quantilygeneralor)or(b)(4l am a srnaf quantity <br /> generator)s we. <br /> GeneraloesOfer&3PrintedflypedName '9ntura <br /> ?11100h Day Year <br /> 6gw �-jlsC n <br /> 1 � <br /> 16.wernational Sh'.pments <br /> hnpat to U.S. ❑Expel from U.S. Pont of entrya'ex,Y <br /> Transporter$."lure(for exports only): Date tearing U.S <br /> 17.TransporterkkrwffWdgmeni of Rec e:ytof Materials <br /> Transpoder 1 Pratled/lyped Name Sagname Mwh Day Year <br /> a 4 / f Q <br /> Transporter 2 Printad7Typed Name S gnature ht"th Day Year <br /> 16.Discrepancy <br /> 18a.Discrepancy fnd:•cat n Space Quantity Type ❑Resdue ❑Partai Re*t-on ❑Ful Reed. <br /> Manifest Reference Number. <br /> 18b.Allernale FaaLty(or Gene(ale) U.S.EPA ID Number <br /> J <br /> U <br /> L" Faci.h yrs Phone: <br /> C318c.Signatute orAttemate Faaf'ly(or Genetaloo A!oath Oay Year <br /> d <br /> z <br /> 19.Hazardous V9asle Report Management Maltod Codes(Le.•codes fa hazardous maste treatment,disposal,and retydk4 systems) <br /> 20.Designated Fad41y OAnet or Operat .Certifi allon of rlmlpt of hazardous materials covered by the mandest except as rated In Item 18a <br /> PrinWaypedName S�nalure t!an)th Day Year <br /> EPAFort8700.22(136%3.05) P(ovioos oftoftareobsolete. DESIGNATED FACILITY Tt]DESTINATION STATE(IF REQUIRED) <br />