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Please print ortype.(Form designed for use on elite li2gA10h)t wller. FOrmAppmvad,OMB No.2050-0039 <br /> UNIFORM HA7ARDOUS 1.l9eneMtor 100 N�ulmber CCC 2.Paguiof 3.E,7KUoacy Raspunsa%/wnu a.ManlfoetTm7 Number <br /> WASTE MANIFEST C ./Z0�02-1 b556, ZFt� �� I`..Y-�Z X15384482 J�1K <br /> 5.Gerremtors Name earl Mddmg AddtP55 Goncrn!u/.Silo A<.Urcss(u,Lnu,¢rl mart nmitigq admesej <br /> JO G EL 10411 IAA 0�—D ZZ 2Z 5. S?4 CLNI(� h\IE. <br /> E NH R5 e-ryl W-X JI-T JCLE L-YlJ WO�9 STdGl�T D1J , Ch R SZl S <br /> GLrlera4x'e Phone: —50 <br /> 0 <br /> 6.Transpad¢ra Camiwrygama U:5.q4\ID NumLar <br /> lZ� s-- nN� cr+ 2�aor� 7� Zz <br /> 7,Trav,,xr ea 2 Company Nome U.S.EPA 10 1,14,11aa( <br /> B.Dee"lod larky Nano and SlleAldrdssU.S.EPA ID Number <br /> US ccol.o �L susi3�.47'7Y � 41-1003 <br /> •n-wY 6t <br /> Fadli's Phone: 6"D 2- <br /> ,z. <br /> gp, 9b.U.S.DOT Description Onekldig Proper Stripping Name,Hazard Class,ID Number, Io.Conleiners II.Total 12.UNI 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Ouanlky WIAld. <br /> ad -3a '-z `7 f1z of s w �7 5at._IDa POO lel <br /> o x �- ° s� 9 � 2 C1 (I �rI D� c F- 1-311,7 P <br /> x z.cIM p DI Ft�o7 SN N � 1 N �7 s w i-Tr l Q j< I-JA Irlh L-1 ( l" 510 P I <br /> 3. Iv <br /> I <br /> I <br /> I <br /> a.yadalHuagNghuhudmsamlAdditional lnlermodm t.o pR-+� FI 0Zn7-3Lf593— <br /> r I..tIxFD CiILGET S' 7�-a{ �-5 y�p) (,�# D'j01Z8303'ILI �`� <br /> j�{%LCTC R-. ,SW c.LP3 L4 Q'+\(LO/2_• 5 P <br /> S * 3 tf z-O <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION! Iwary declare that the contents of this consigomenl are fully and axumtely described shave by the propar shipping new,and Oro desaebd,paJepad, <br /> marked and labaledloacarded,and are N all respects In proper condition for transport according Io applicable International and nationalgwemmantal regulations,If evind shipment and I am the Primary <br /> Exporter,I scary that the contents of this consignmenlconform to the Iowa of the attached EPAAcknoxledgmenl of Consent. <br /> I coal that the waste minimizationstatemenlldmliAed In 40 CFR 262.27(a)Oil em elaryequmtity gemrelor. d 11 two sinaequNdilViyrmmWrjelrvc <br /> GanmalW amh''Prnl^^edrrvMd�Nmna ono N—* Day Torr <br /> W Lt'v— ILv 4 <br /> 10.International ShlPMMM <br /> F. Li Import to U.S. Export term U.S, Pod of miry/exN: •...__.... <br /> TranspMor sigrminl e(focexd'orls any): Dale leavlfg U.S.: <br /> ¢ 17.TrareporlerAcNnoxladQnen f Receipt of Maledals <br /> oiranspwier/Plin i T)ped Sg 1n blotto Day �ur <br /> elute Month Day Year <br /> za Transporter2(MnledlTypeJ Nan M9n <br /> K <br /> s— <br /> } 18.Discrepancy w <br /> 1Ba.Disrre n Indicallon5 ca <br /> cY pa LI Quanlgy Typa Residue ❑Partial Rejection I_1 Full Refection <br /> MAY �MAY <br /> n <br /> 9. sl floiwen[v MnrbF,r. <br /> Btb,Allemzte Fadliy(m Generator) U,S.LPA ID.w1wor <br /> :3 ENMONMENTAL <br /> LL F' We Phone: `C ,nr •+ <br /> w 18p.SVnalmo olAlwonN I acil,ly(nr Gonmalra) Monty Day Year <br /> 6 <br /> 2 <br /> y19,Harardous Waste Report Management McNod Codes(La.,codes for hazardous waste liniment,dlopmtl,and reoycMpayslams) <br /> 0 1 2. a a. <br /> 20,f�-a i,ur!m1 aci11y0wnera OPers,Cemhca9on ai rarnipl f azmdaus maleriaH covered bythemardlpsl except asnded In Ilam lBa <br /> 1 MIaIc,UlyMd suyra n h Oay az <br /> EPA Farm 57011-L2 Rev.:143) favinusod1honsa 0101et0. 11ESIGIIATEC9 FAC,II-ITY TO DF.;TIhIAYIOpf STA(F(IF REQUIREt71 <br />