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<br /> Please print or type.form designed for use on elilel2- itchtypewriter.) Form roved,OM8 No.2050-0030
<br /> UNIFORMHATARD0U8 1.Generelcr lDNumher 2.Pa8ef of 3.FmerBmwy Response Pima 4,Manifest TrackFg Number
<br /> WASTE MANIFEST . ..,r.„ - r r ,,?.,x> .v .1' C*0 U* 336011.4 JJ K
<br /> 5,Generators Name and Me11IngAddress Generators SReAddrese(d different then maitry address)
<br /> ii� 7 S:`CrUTI l i5fiia.hi•`t+;i?II
<br /> Generators Phone:
<br /> 6.Transporter l Cempany Nemo" U.S.EPAID Number
<br /> t7�•.Lli!?3 r_11tlllit'!iHldl;bii nl. �t°i �!)� ;_ 1�•A!: i;,'.1?) 1(df'e�L"+
<br /> 7.Transporter 2 Company Name U.S.EPA ID Number
<br /> 8.Designated Facility Nam and SileAddress U.S.EPAIDNumber
<br /> G;f.',:'" . R.-NO I")t"011001'r•,l L("
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<br /> A;:dlGl u7(111)1",Gi)':-+,r;.5. !i37.12
<br /> Factiit's Phan
<br /> fe Ob.U.S.DOTDesaiptonincluding ProperSNpp:ng Now,Hazard Gass,ID Number, 10.Contelin it.Total 12.Una 13 Wasle Codes
<br /> HIM and Padding Gump(it arty)) we. type Duanby WUVol.
<br /> 1' Vrr.4};Tiu 00;JillI c',rI(ICE' I1(41.l!I}, 1,10%. Pin I%rF0,R0iI! tbll., IIFk+FAIN!
<br /> 51 X,11
<br /> 2.
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<br /> 3.
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<br /> 14,Vpedal Handling me AdGdona nformsddl
<br /> •;..i ii Ci51'i(:I<.2 ltA,l'•11 C)`Ri) �I b:31.11.17 fiL": •h71!t d!f1 1R�16Ik2f) AP:1\,5 IISI? nPi'RUVI*.O 1'I•'.'
<br /> 16, GENERATOWSIOFFEROWSCERTIFICATION:I hereby dedare Nat Ne contents olKs consignment are luty'end aavraley described above by the proper shipping new,erd are dasd8ed,packaged,
<br /> merged end(abeledlpiacarded,and are In all respells In proper widiton for Vem pod ecmding to epplWable Inteieatbnsland national governmental regulations.If axpod 6hlpment end I am the Pdmsry
<br /> Exporter,I oerey that the contents of We gonsynmentconbrm to the terms of the elteehed EPAArknasledgmentof ConeenL
<br /> I cedly that the waste mlNrNzatbn statement Weng6ed In 40 CFR 262.27(x)of l em a large quamiygeneretor)or(b)(dIsm a small quentiygenerator)Is he. _
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<br /> Oaneralo1r'e•l1Off•eyro1re Pd �� nor yrelsl.P'a 1�i /icya,; m Day Year
<br /> ntedflyped mGd2112 ,y '
<br /> �•1
<br /> 15,International UnipmenusLiImport to U.S, ❑Expod from U.B. Podofenuy/ext:
<br /> Transporter swura(f"exports in IDate leaving U.3.:
<br /> 17.Tien ' erAdmarfedgmentofReceipt of Metedels
<br /> Tran dyr n e Name gyne a,: j F1onth Day ear
<br /> O -r!J �.�
<br /> Transporter P Oe Name Sona t Monty Dey Yam
<br /> q. 18.Discrepancy
<br /> life,Discrepancy Indication Spare ,❑ Ouenify ❑Type ❑RuWue ❑Parisi Rl,'Id l El Full Refection
<br /> Manifest Reference Number:
<br /> 186,AItemate FaWry,(or Generator) U.3,EPA ID Number
<br /> LL RO RY$Phone:
<br /> too. ignalureo Alternate Fatuity(a Generate) I,.onN Day Year
<br /> y1g:Hazardous Waste Report Manageuml Method Codas Vo.,codes for hazardousymste beatment,d4possl,and(acyanrig systems)
<br /> G f 2 3. 4.
<br /> 20.Daslgnal kscday Oeneror Opereldp Cerilficaton orrerelplorhazmdous materials covered by the manifest exyept as noted N Item l8a
<br /> I Sigrmyre/ r Day yePr
<br /> n Namel 1 } \z. t f' i ' I .I r i'1`. ):% (
<br /> 1 t it i 1:�.,(!: C i 1 r , 1. ! r r �/ r +... < 'i ', t .'.
<br /> EFAForm.8700-2 (RBJ )Prevlou§editions are obsolete. `- - °'` +� RANSIs F_I3'S COPY
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