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Please piml ortype,(Pon designed for use an ago(12-pllct)lypassrher.) Form Apprarod,OMB No.2550-0039 <br /> UNIFORM HAZARDOUS I.Go eman lP No f_ 2.Page lq '3.Emwg qRgsPmso Phoria A.Manifest Tracking Number <br /> WASTE MANIFEST ([/ 71 7 -so2q015384204 JA <br /> S.Genankts Name aul Eta nese et sShbAddreal(ifeleent Ikan m.1%address) <br /> �S �FlN(NcfSzix,�ZoN L 25� �� <br /> ;Z'Z;Z-2- S . S/tw&& 2 Ste^ <br /> Ganamlors Phone: 9 d C — ✓0,3 <br /> &Tmnapoler 1 Coagsalry Nama U.S.EPA 0&limbar <br /> g can PE 7`'Z <br /> 7.Tmn,udlm 2 Comparyliamo U:S,EPAIO NUMen <br /> 6_peyab wNd Fnulrty Nxnoand Si:oAddrams f2C q.TT7/ US,EPA ID Number <br /> �eoc06Y IVEvogoA J 7 <br /> t!u^! qST 11 rtr[ Es s. a" ejEvnna Vgbo13' <br /> Fadill Is Phone; ©o — ✓T 0oi0ocy> <br /> ga_ 9b.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class.ID Number, 10,Conforms 11.Tolal 12.Unit 13.Waste Codes <br /> HM and Parking Group(it any)) No. Type Oaengty "Vol. <br /> N� CL/F?za422�a�` r�s7g, �`olcD, P7 r F clrr 00 D. I..I <br /> 1 <br /> 3. <br /> 4. <br /> t Spade)Handling llmbumormmadAdddlono Inlormsoon !O (yx Y�yQps <br /> t lt(K6P <br /> 2Or(b <br /> 15. GENERATOR'SfOFFEROR'S CERTIFIICATION;l hereby declare Nat The tomenta or We consignment are fully and accurately described above by the properehlppkig name,and are classified,packaged, <br /> marked and laboledlplacarded,and are In all respects In proper condition for transport according to applicable Nlamallonal and national governmental regulators.Iloxport shlpmsm and I am the Primary <br /> Exporter,I tardy Nal the contents of this consignment cenfonn to the tames of the affected EPAAckm viedgmenl of Consent. <br /> I cetllty thal the waste minindzagon statement identified in 40 CFR 25227(e)Off am a large suably, or(b)(11 am a small quangy generator)Isbue. <br /> (;Iwau;r.lGlfomrY Pdme0fryla)Nam Sana Zfe , Year <br /> hNm1L1G Y2-[ z D <br /> —, 16 olemalkmm ank <br /> P ❑Import to U.S, ❑Export from U.S. Pod of entry/exiP, <br /> Transporter signalu a or exports Drily): Date leaving U.S.! <br /> w 11. of Recalpt of Mmodals <br /> K transporter 1 Primed? NamTi V2,1 S <br /> A'bM1ilu lamnN D Y ar <br /> 6 <br /> TrwIspo4 2 Prntedrrypod Name SignatureU IF Mon.. Day Yea. <br /> lir <br /> r <br /> to Disuopamy <br /> p �aa e� � <br /> Its,Discrepancy Indication Space ❑Due off ❑ "d _ iy�- ❑PaNal RejeGion Full Rejacllon <br /> �S.�:Lm. lkal alaenca NnenbM: <br /> 15b Allamate Facilily(or Generator) 1r),j\/ py f �0(y'� U.S.EPA IO NumbN <br /> 7 f =19 U <br /> U <br /> LL Fxapjs Phone: - <br /> w 1& EMIlReN ' rSgnalum ofAllemele Fetdly(or Cwrrarala) ` ' Month Day Year <br /> z <br /> � 18.Hazardous Waste Report Management Malted Codes(I,a,codes for hazardous waste treatment,disposal,and rocydirg systems) <br /> 0 1 p 3. 4. <br /> 20.Desfgnpled Factly Owner as Operator.CeNfcalian of receipt of hazardous maledals covered by the manifest except as noted In Ilam iba <br /> PameanypedF Slg�abr t Monty Year <br /> CPA Form 6700-22(Rev,3.05) Previous editions are obsolete. DES f.7,T2AT LD f AGILI)Y TO DESTINATION STATE(IF REQUIRED) <br />