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Please print o r type.(Form dcsiDi od for use on elite(12-pitch)typewdior.) Form 'proved!.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS I.Generator ID Number 2.Page l of d.Emergency Respmrn:I'Imrn: d.Mantfrst Tracking Number <br /> WASTE MANIFEST C &b2�65b i 09 ;; -saz�F 015384447.. JJK <br /> 5,Growl ➢Name and l8adkrp Agri C•aneeuor's Silo Abbess(11Qltof6ru than haring Ird.anres) <br /> EGS ,gFItJity-. T LLG <br /> 2222 S. SlNGL tK t9 - S'C66� -- N t� ag2os <br /> Gonomfor's Phone: — a3c) <br /> U.Transporter I C xnpoey Name US,EPA ID Huerbtt <br /> �2�ST �yNfl SONS F8�4z �. <br /> 7.Transporter 2 Company Name U.S.EPA m Number <br /> 8:Designated Fadkty Nana mrd SiloAddmes U.S.EPA IO Number <br /> CM r-'r Loc-+Y NF'VJ4cjmr N6Vl4Vj4 Sg003 <br /> Hwy a5� IIMy s s. OF <br /> Facig)s Plone: 60 q- 4Ar INV '3to <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,10 Number, 10.rentalners 11.Total 12.Unit <br /> HM and Packing Groep If any)) No. Type Qua. WI.Nol. 13.Waste Codas <br /> 1Nw l-00v.S WASTgG, sol✓110, <br /> Wo N,ors, �. Iia la& CLIE440) 0 U' <br /> w2 <br /> 3. <br /> 4. <br /> 1 Spout HruMing lnclm[Uons osmlxidiBxmllYormaedn <br /> t�p'WWCE� Wi,lxT WF4.E-#0,+0734sq3 — I <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION:I herebydedaelhallhecantaMs oflhis cansgamenlare fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and MbefellpinDrdod,and are In all respects in proper condition for transport neo ding to applicable inlematbnal and nalbnal 9ovemmenlal regulations.If mind shipment and I am Na Primary <br /> Exporter,Icarttly that the contents of this conslgnmenl conform M the terms of the abashed EPAAcknowledgmentor Consent <br /> 1 cadify lost the waste MnYnizallon statement Identified in 40 CFR 28227(a)(N I am a large quantity generatnQ a(b)Of am a small quallNy Fare()is true. <br /> G..^.0aalm'aKsOUra'S PdnlecirTypaU Name swllu roMh Day Yo+l <br /> I .O U Oa IZ I(a <br /> a 16.Intemallonal Shipments <br /> (— ❑Impodlo U.S. ❑Export from U.S. Pod ofentrylesll: <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> W 17.Transporter Acknowkdgmanld Recegatol Materials <br /> TrmsSpaWr I Pini ul y}ied N;.m 6xl"mluie A Dey Year <br /> 491 so <br /> Tnanspoder2 PridedlTyped Nang Signature Month Wy Year <br /> rY <br /> s— <br /> ♦ <br /> 18 Discrepancy <br /> 1Ba.0iscrepancy lndlcalbRECEIVEn Space rl (luardly 1-�Type RD Ilan ❑Full Refection <br /> Mani! t lerenc N bar <br /> 18b.Allemate Facility(or Generator) +rj-1,i ( S. <br /> FPA ID Number <br /> J <br /> U <br /> I Famliy'a Phone: <br /> w sBe.Signature of Alternate Facility for Gonamse(f PEMIT/SEWCES Month Day No <br /> z <br /> y19.Hazardous Waste Report 6lanagemenl Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C I, 2. J. 9. <br /> 20,0embreled Facility Owneror Opomlor.Codification of receipt of hazardous ma ones covered by the nage l axca las nded N Item 18a <br /> PllntedfTyped I^ �1 ""' MI '11, 'Mar <br /> ft <br /> EPA Form 870022(Rey.B-DS) Previous editors are obsolete. 0ESI(;NATED FACI.ITY TCI 1)I°;'1'II IAT 10N STATE IV- Fl FI II I iP I'I <br />