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Please print orlype.(Form dustlithad for use on elite(12ryhch) Wager. Form Approved 0MB No.20500039 <br /> UNIFORM HAZARDOUS 1.CompontorlD Number 7.Pagelol 3.EmaiReapm"Phone / 4.MANfeat Trashing Number <br /> WASTE MANIFEST �FO 2� �. 0) L 1015384372 JJ K <br /> s:Gemmwes Name and MaNmjAddress snare ors S0 Mfoss(ddmorem mon passing nddross) <br /> t>EN65yS <br /> 6-U155 P2oC4-,�10 G q�2os <br /> Generators Phone: - 7 74— O <br /> o.Trompoderl CompanrNo= US.EPA 10 Walter <br /> LA-ST 0A)g SDN 0 01 4 W- <br /> 7.Tmnspona2CaipanyName US.EPAm Number <br /> 8.Designaled Fadkry,Name and Soh Address U.S.EPAID Number <br /> ltiS oLo�U 106-wq 9A <br /> r 11-V �tSy 1r Mt�5 s of ��3, ���wo a Srgoo uT o o0od <br /> Facaltrs Phone: <br /> go. 9b.U.S.DOT Description lincluding Proper Shipping Name,Hazard Class,ID Number, 10.Cardamon 11.Tatal 12.Unit 13.Waslecodes <br /> HM and Packing Group(if any)) No. Type Ouantlty WWOI. <br /> !✓�? X7-7y NyzW/ +tis <br /> w <br /> C SoLr N. P6- rue it9) to 03 P — <br /> z 2. <br /> 3 <br /> 4, } <br /> 6Spec ht Handling Instructions and Addrsoial lnfommlka, PERMIT/SERACES <br /> 0(69 Ct -(-C C f 1 <br /> >✓tc.c * O <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby appear that Ne wnlente of this conslgnmsnl are her and accurately described above by the proper shipping mine,and are classSed,packaged, <br /> marked and gualedliplacarded,mid are In as respects In proper condition for popcorn according to applicable international and national governmenlal regulations.If export shipment and I am the printery <br /> Exports,I ceNfy That The mrstems of this consignment conform to the terms al the attached EPA AcknoWedgmant of Consent <br /> I certly that the waste minimizationsfampro lidentiffird In 40 CFR 28227(8)(SI am a lame quantity gonareta)or(b)Ifl am a small quantity generafar)Is true. <br /> GanamlorsfUlboofs Prmledlfyped News or Momh Oar Y- <br /> 1010,)-4 <br /> 03D 16 <br /> ❑Export ham U.S. Portorenl /exiC ,___ <br /> 11-r 16.lnlenakeral Shipments- Elation to US. ry --- <br /> Transforms <br /> -Transo ms 4014 o-(fereVurts(call Date leaving U.S.: <br /> of 17.TransporterAcknowledgmenl of Receipt of Materials <br /> 1- iraisiwria p"PllOypea Naar, � ) 1 Spin `� (/-yy�,y� � /� lbonlp Day Yaar <br /> ao �\//v CST eC�J" �(�' I 1y5'+' oC oa 16 <br /> 2 Iin,,oulm'l.lichen Typed Name Signature Mori Day Year <br /> } Ia.Ohnrpancy y--� I� <br /> Its.Discrepancy indication Space Elpuaniky ❑Type ❑Rosldue UPorml Rejedem LJ FWI Rejection <br /> Mamlest Reference Number <br /> 18b.Alamein Facility(a Generator) U.S.EPA IO Number <br /> J <br /> U <br /> LL FinTlys Phone: <br /> w 1&.SlgTmure olAllemate Fa Ity(ZFGsnaato0 Mmlh Dry Year <br /> a <br /> z <br /> � 19.Hazardous Waste Report ManagamgBlAefhad Codes(ce,codes lorhaxardouswasle treatment,disposal,and recycling 5yalelR5) <br /> p 1. <br /> 20.Designated Fadlity Owner a Openlon Certification of recepl of hazardous materials covered the manifest except as noted In bem lbs <br /> Pdimaii SllgnaNm Day I Y" <br /> EPA Form 8?*22(Rev.3-05) Previous editlma are obsolete. DESIGNATED FACILITY TD DESTINATION STATE (IF REQUIRED) <br />