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0 0 <br /> Please YnlatyRe.(Farn derskylad for useon"Ite(12-Pitch)typewriter.) Form ApproVad.OMB No.2050A039 <br /> i.Generator lO Ndmber 1,Pagald 3.Emefg lw5•Reeponsaphono 1.Manifest Tracking Number <br /> UNIFORM HAZARDOUS � 4 55� _ 015384199 JJK- <br /> owneassai stn ndA:aea la dnerullf won maulns admen) <br /> �.S 12�(N nV�-- �, s zoct--rc� cs4 • a 5 20 s <br /> Gunomloln Own; 5-MC-) <br /> US:EPAIO M14mba <br /> 6,Ttanelwnef 1 D 1113Py Nanw /. <br /> LLS•E°A IO Numbs' O• <br /> 7.Derupmter 2 Canparc/Nems <br /> 8.Dusipated Faft Nana aM SM 14116 U,s.EPA IO Number <br /> lA S EconUGC/ <br /> w q5, tf f�f S s, 8�ov3 n <br /> Fac spleno: o ?iCl' U 3�oo 10000 <br /> %.U'S.DOT Oascnp0on(mcludng proper shipping Name,Hazard Class,to Number, 10.O.1hriner5 11.Totxl 12.UnM 13.Wasle Godes <br /> 9a. NJ Type Quantity MAU. <br /> Hh1 <br /> and <br /> Packing Group Alany)) <br /> o <br /> 1. 30 (-419tZA120o wl�szr✓y soap, pcv% .1431.1 <br /> N <br /> 2 I i <br /> 1 <br /> a, I t <br /> �1.SpeoWl VlamN�grnalni[bpnfi imd Addi11a1N lnfdrwaal fO �{'{'y(�(y ]ZIA.J <br /> pq IXE� Gu-�T <br /> 15. QENERATOR'91OFFEROR'g CERDFICATION:Thereby declarethat the cotAenledwisconalgnmeol ma luMyand aztu,aloty daswfied abmreWU:epoper sh�Ping name,and arec!I amthepadaged, <br /> marked and IaheMdlplaarded,entlare br NI respells in proper cond!1'ron for uanspao eccoNiry'n eppOrabk InlernolbnAlerd relwnal govorrmanlal rotrylatlons,II oryon ehlpmed nml I am the Primary <br /> Exporter,)ceRFy thathe wnwnls of Ihls consignment conform w the loans of Na adadiad EPAAcknoasedgmed of Coasuu, <br /> I c,,ij Ilial the waste Mnimiza8on swwment Wentleed in 40 CFR p51.2J(a)A11 amaIxrgo qusnl'Ay generator)or(bl All Bmasmall qumslygonaaldjhm:e. <br /> S:gnatuv Month Day Year <br /> Generaloisl08uu!s PddedTpad Name ` 2� <br /> fLTF—f�J kJ <br /> ,124 <br /> ntom <br /> 16,Iedmul SNp1_I <br /> menls Impart to U.S. ❑Export from US, Pa;of entry/exil: <br /> zDate leering U.S: <br /> Tmaspeder s!gnalure(for expats only): <br /> w 17.TleropalerAdno'adeugmwotofReceiploRAeledah <br /> //-� �/ Monty pay Test <br /> or. a1PIm1�1ypnnrlanw U (t4� if SO'7 `sem �'_/'1 ��-- �� VI G <br /> Z Thplixtru 2PhnledRYPnJ ienn SlgrwMe I,1mlh Ory Yrwv <br /> rY <br /> r <br /> } 16.D,xlepency <br /> fear.Discrepaccy lndiealien5paw n OuanGry, 4_�Type7"`m' U Partial Reje,ton Ful Reledbn <br /> d7- <br /> Manifest Raterrom n.or. <br /> Yr PA ID Number18b.Alternate Fadlor(or Generator) Us.E <br /> Zi <br /> U <br /> u FadUjs Piwre: <br /> ONIN17KEAL FfF_.e-.L7}j Maml O:ry Year <br /> w h si9ua::na olNlamale ParAily lar Gc:2mloil <br /> z <br /> $ 14 Flamndmn Yyasle Rnpnn tAanxgamen;Maroc-0Codes{Lo„rodes wrtrezardous e:as!e bealmem,maPrral,and lesN:an9 syslnns) 4 <br /> il-twirn: <br /> , a l Facirty Owner or Ojoraoc 4tlrnMn of receipt of hazi:dous mxtsria!sco:ereA Ey the manllssl exrep;os ndaAin llsm lea r „y� Cry. You <br /> r 5 _' r�,� s t re � "J\mss' (J 1fG_1 <br /> EPA Form 9700-22iev.3.05) Pfev!ousedilionsare ubsolsll% phSIGNATCOFACILITY TODESTINATION STATE(IF REQUIRE 0) <br />