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Please print or type.(Form designed for use on elite(12-pi(ch)typewriter.) ForrnApproved:OMB No.2050-0039 <br /> NIFORM HAZARDOUS 1.GenemlorlD Number 2.Page i of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ASTE MANIFEST 01343526 . JJK <br /> e eralo{s Name and Mailiipp Addless G eratoes Si(eAddress(if different than mailing address) <br /> t<- cr z <br /> � vC,` 1 l'lf"fl ,. IG'•:A71Cfi " , ""� A W <br /> un 9 •ice. - <br /> Generators Phone: <br /> 6.Transporter 1 Company Name FEB - U.S.EPA ID Number <br /> reor;e irv. [-euro,Inc.. <br /> 7.Transporter 2 Company Name ar a... - U.S:EPA ID Number <br /> H�A�Ty nFQaaT��^��7T <br /> B:Desgnalpd aclldy,IJalnea(ldrsile Artdress U.S.EPA ID Number <br /> r:.15t:3WiI; street <br /> Factlitys Phone: <br /> ga,_ 9b.U.S.DOT Description(Including Proper Shipping Name,Hazam Class,ID Number, 10.Containers 11:Tolel 12.Unit 13.Waste Codes <br /> HM and Packing Group(f any)) NO. Type Quantity WtNol. <br /> )z 1. '_1n11?2: 4i1(R7E Fj,,tNV"W'FR.E L31dO 11.. •x a r+e,Ia�c) PC i i --t :}Irl <br /> W 2 <br /> 3. <br /> w <br /> f7 <br /> 4. <br /> 4:5 eaal Handling InsWctions and Additional Information - - <br /> Kr ra l.ze .,. ty.7rt?errnllD.3:its mill F_ttry;Ketorue O "plipe glue - 36 <br /> - <br /> L�G It•EtG i <br /> 15.- GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by Ne proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I ceNfy that the contents of this consignment confarm to the terms ofthe attached EPAAcknoWledgment of Consent - <br /> -I cerfify that the waste minimization statement identified In 40 CFR 262.27(a)(if l am a large quantity generator)or(b)(if I am a small quantity generator)is true. - <br /> Generatoesl0ffers Pdntedrryped Name i - - Signature - - Mo Day - Year <br /> gr 1 ,` <br /> jq jig <br /> - ,16.Intemaffonal Shipments <br /> F— -. ❑Import to U.S. ❑Export from U.S. Pod of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: - <br /> w 17.TransporterAcknowledgment of Receipt of Materials - <br /> a <br /> Transporter <br /> Ia... tej �ypedaneSignature . Moa <br /> pIYSe <br /> w <br /> Q, Transporter Pnnted/ryped Name Signature fl Monty Day Year <br /> K <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type- ❑Residuej j <br /> ❑PaNal Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> LL Facililys Phone: - - <br /> w 18c.Signature orAltemate Facility(or Generator) - Month Day Year <br /> Q' <br /> Z <br /> 7MMazardaus.Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt'uf hazardous materials covered by the manifest except as noted in Item 18a - <br /> PdnlecirrypedName Signature Month Day Year <br />