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typ"Please print or type.(Form designed for use on elite(I 2-pitch) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generefer ID Number 2.Page t of 3.Emorgonuy Respmse Phone a.ManHeat Trackhg Number <br /> WASTE MANIFEST JJK <br /> 5.Generators Name am Melling Address Generators Site Addres>A element man missing address) <br /> Generators Phone: <br /> 8,Transporter 1 Company Name US.EPA IDNumber <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility New em Sit@ Address U.S.EPA ID Number <br /> Fadll sPhana: <br /> 9,. 9b U.S.DDT Description(Ince ig Proper Shipping Name,Hazard Clave,ID Number, 10.Containers 11.TOW 12,Unit 13,Wase Codes <br /> HM and PacaMg Dmtp Of any)) No, DUO" WWd. <br /> 1. <br /> $ ;SixJ <br /> z 2 <br /> u <br /> CERTIFICATE <br /> OF RECYCLING <br /> 16 Special Handing Insimctona and Adz'^-... -.—Tnt nn-"'- <br /> 15. DENERATOR'SIOFFEROR'S CERTIFICATION: I ne eby dedare that the contents of this consignment are fully and accurately described above by the prooer shipping new.and are classified,packaged, <br /> marked and IabeledlplacaUed,and are it all respects in proper condition for latsoort accord'mg to applicable intemaional and national governmental regulations.if extent shipment and I am the Pdnary <br /> Erpoft,,I tarty that the contents of this consignment conform to the terms of the anaded EPA Acknowledgment of Consent. <br /> 1 cer*dust the waste mininizaticn statement identeed h 40 CFR 262.27(a)(t l am a large gtedity generator)or Ib)(91 am a small quar"generator)is nue. <br /> Generator's 011erars PnnfeNTyped Name "All fle/���� Month Day Yeer <br /> i , G 'y1 -2 19 1140 <br /> tint sNpmen' . ❑ImpdteUS. ❑Export Ban U.S. Port at entry/mot._. <br /> z TranapMerslgraase(fnr opals 00m: Dare laavingUS: <br /> W 17.T2nspoderAcknow"nsaM of Receipt of Maladds <br /> Transporter i Pdnted,7ypso Name signature Month Day Year <br /> renspakr 2 Pnp*drryW Name Signature ke, <br /> r <br /> 18.Discrepancy <br /> 18a Discrepancy h6cadan Space ❑ Duna*, ❑Type ❑Resotue ❑Few Rejecton 7-u'.l Rejection <br /> Manifest Reference Number. <br /> tab.Htamab recta,(ter Deumaeor) U.S.EPA ID Number <br /> J <br /> u <br /> W Fadmys Phone. <br /> Q Signatum IemMe Facility orGenerator) Montt Day <br /> YellerFLI I <br /> S2 19.Hazardous Waste Repot Maregmnant Method Codes(i.e.,codes for hazamo.ts wasta beabrerl.disisosal,and recycling systems) <br /> 20,Designated%adley Domer or Operalor:Ger0Lcalion of receipt of hazardous malacias=meed by he(mo iieM except as noted in Ilam IW <br /> P, I/TyTM Name Sgrature Mahn Day Year <br /> EPAFof, ' '00-'7(Rev.3-05) Praviouseditiors areobsodete. DESIGNATED FACILITY TO GENERATOR <br />