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Please print or type. Form deslgnad for use on alife.l2-pitch)typewnler. Form Approved.OMB No.2050-0039 <br /> l UNIFORM MANIFESTS 7.DeraralwlDNuinber" Z.Pagalol 3'E°nrgenv/ResponsegqPhalo " 11'It�°�8"4423 JJK <br /> WASTE MANIFEST � . 6 7 J 1 <br /> 5.Cxmeratoys NAM and IdmTev4 Aodr4 Gereraw s Site Address(if d8vranl Than maMng address) <br /> p-��.T fur-sits c'�'r�s <br /> Gonwalors Phnoo; t'f Gf <br /> 8.Transporter 1 Company Name U.S.FPA ID Nu num <br /> IUS O� Oti/ C G 4-oro 5 <br /> 7.Tmnspoder 2 Compwry Neme U.S.EPA O NUnoer <br /> 8.Designated FaCBily,Name and Site Address � U.S.EPA ID Narrow <br /> as crceo&y NEV►�ol� ggoo� <br /> or 39 P�artop v'T 3 '�71OG00 <br /> Fadfay'a Phone: � <br /> 9, 91a.U S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 18,Containers 11.Total 12.Ural 13.Waste Codes <br /> HM and PacHngGroup[if anh) No. Type Quantity WY.Nd.1. I dJ <br /> o <br /> 0-7-71 lfE7zAR3bu5 wgs7� l SOL R7 I$/- avy--__... <br /> .o•s F� ti GF <br /> W2 <br /> RECpF I — -I--- <br /> 4. PE Ras .q s <br /> 0) <br /> 14` Fg li <br /> .Spe el HBOOrginst,UCIWSWdAddlaonal nlormelbn /x „/ n� <br /> M k "U 41ST <br /> g .. c E # 0701-51C q <br /> 15. GENERATOR'SIOFFEROWSCERTiFlCATION:Ihere6y dechie Nal owntenls of d,h wnslgnmenl are luay entl ewura'aly descnb:d vboveoy the prepare.IpyAng name,artl am dasalfied,packaged, <br /> marked and labeWpiacarded,and are In e0 m8psch In pmpwcmdi0on Iw transpod ewordiog to epplicallo Mlwnal'ronal:uM national governmantal regulations.II export shipmml and I am the Primary <br /> Exporter,icedHy Net the CgnMnls ofInnsredIdea wn40 Cbthelerins of I aahaclnd FPAAcy firmo flar)E fill!ent, <br /> l oediylhal the Waste MnllNzalgn statement Wonllfed In 40 CFR 262S7(a)(8lamelmge quaNlly gorwmlor)or )011ama6ma8 quan0lygmtmabr)Is We. <br /> Gtns:nbKMOMnrcts RI1Zrypad Nama SI o Mood, Day Year <br /> .- 16.mlemetlonal$hlpmmts ❑Import to U.S. fm❑Expod m U.S. Pod ofenlrylexlt: <br /> Transporter slgnatmo(for exports only): Data leaft U.S.: <br /> 17.Transporter Acknowledgment of Receipt ofMotor" <br /> be Traropcnerl Pir rfyped Nonm SgnaMO month Pay Yam. <br /> Q <br /> 2 T sp«1ar2 MI rymnd Name S v hlonN Dry Yem <br /> Q <br /> a <br /> i18,Discrepancy <br /> 18a,Discrepancy Indication Spam ❑ Owngy ❑Type ❑Reaidue El Partial 110clim ❑Fall Releepw <br /> Moment Rekrwrce Number: <br /> 185 Alternate Facility(or Genefiloi) U.S.EPA ID Number <br /> 7 <br /> U <br /> 1 Facility'.Phone: <br /> w 1Bc.Slgnatureol Allemale Facaady(or enerelMwlh Day Year <br /> Q <br /> Z <br /> h19.Hazmdws Vlasle Report Management Method Codes(i.e.,codes for hazaMouawasteVeatmenl,disposal,and reryding systems) <br /> O i' 2. <br /> 3. 4. <br /> i20.IW.signalod ;JRy Owner or Operator:Cerafical'mn of receipt of hazardous materials capered by the marld6al asm sndad In BemlBe <br /> PimladRsry+d M Me nN Oay Year <br /> EPA Form 0700-22(Rev.3-05) Previous edltfons are obsolete. DESIGNATED FACILITY Td DESTINATION STATE(IF REQUIRED) <br />