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----��_ RECEIVED <br /> AA'' FEEBB�2 4 2015 <br /> Pleas dnl of type.(Form designed for use on elite(12-pitch)typewriter.)- - ENIVI 11I9t1 V <br /> 11 ORM HAZARDOUS 1.Generelor lD Number 2:Pageiof 3.Emergency Response Phone 4.Manifest Track fy nCDrI DTA,1C 1T <br /> ASTE MANIFEST, '. r'� F v"D^t•"�:;i>•� — 7 2.7 r_.J..r'.I 0134„y3, 5261 JJK . <br /> 5.Ge eratots i•�amg and fr��aili gmgrws Generalo?s SileAddress(i(digerent than mailing address) <br /> \ 14. t1Ud.''rli -i:+r a%RIG <br /> Genemloes Phone:... __ .. <br /> S.Transporter l Company Name - - - U.S.EPA ID Number <br /> .f.:r_ nrB@''fv.art'ttffd.INir. <br /> 7.Transporier2 Company Name - U.S:EPA ID Number <br /> 8:De Baty-0 aciIily kin n wit—silgMArnaa - ; U.S.EPA ID Number <br /> LON Fq.G:r CA 906'13 <br /> FaulilyaPhane: <br /> 9a,.- 9b.U.S.DOT Description(nciuding PmperShipping Name,Hazard Class,ID Number, - 10:Containers . 11.Total 12.Unit - -13.Waste Codes <br /> HM and Packing Group(ifaay)) No. Type Quantity WINal. <br /> 7t' 1 Iff f1 ? 41`•:rL= F! viF:!;`',�'!.E!t^+1 t16 i1.. V.S. dtee kii:r) R;s'i1 --) :Yfi: -Z a '.'Zi fY:f_si <br /> w 2 <br /> C7 <br /> 3. <br /> pr <br /> 4. <br /> 14iS�edal Handling lnsWckons add Additionallnforma8on - - ' - <br /> _.'t{Ux•t.u� -: 1 7i1p'L'P'.•95iD S:1dl+xflFf`:$it!ri i?.:BDP, iy '.^,yl,2 Diiic <br /> 52']tJ3 6" <br /> 15:"GENERATOR'SfOFPEROR'S CERTIFICATION:Thereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,ard are classified,packaged, <br /> marked and labeled(placarded,and are in all respects in proper condition for transport according to applicable international and nalk nal governmental regulations.If export shipment and l am the Pdmary <br /> ' Exporter,'I certify that the contents ofthis consignment conferee to the terms of the allached EPAAcknowledgment of Consent <br /> ;Lcedify that the waste minimization statement identified in 40 CFR 262.27(a)(if l am a large quantity generator)or(b)pit am asmall quanhty generator)is true. <br /> GeneralorsU errs Pdnledffyped Name i �; .) j- - Si9�alure r r f r , Oil _lees <br /> .. 7 f <br /> Moth <br /> .16.-Intemalkmal Shipments <br /> ❑leepod to U.S. -❑Expert from U.S. PodofenWexit <br /> Transpodersignature(forexpods only): '- - Data leaving U.S.: - - - <br /> 17.TranspoderAcknovdedgmentofReceipt ofMaterials - "•> <br /> Transportert4 nledJ/�yped Nam/ej //,i. - - Signature /'r 1., '.Mopl� Day Year <br /> o Tmnspoder 2 Pdnledffyped Name Signature - Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy.lndicafion Space •_.❑ quantity - ❑Type EJ Residue .. -❑Partial R41all n ❑Full Re)ecgon - - <br /> Minified Reference Number. <br /> 1B5.Altemate Facuity(or Generator) , ;., U.S.EPA ID Nueeber <br /> FaqI&s Phone, <br /> j 1 adore of Alternate Facilty(or Generator) - -. - - - Month Day -..Year, <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems), - <br /> 1 1. 2. 3. 4. .. <br /> 20.Designated Facility Otmeror Operator.Cedificagon of receipt:4thazardous materials covered by the manifest except as noted in Clam Its <br /> PrinledRyped Name Signature - Month - Day Year <br />