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Feb. 23. 2015 10:24AM GE W LOWRY, INC . No. 7216 P. 1 <br /> . Please' dnt•e PamEes ned'foeuseon'elile'42''b1n :':- W". w <br /> ( � )bPer�) ' , ..• ... Fdiltf" "Yfyrps(gNp:�e..;;: <br /> UNIFORM HAZARDOUS 1.GsneratovlD Note, 2,Pagetof S.Emergenny Response Phone a,Meplfest Tracking Number <br /> WASTE MANIFEST GrV{EdKd4?01S '1 :is'kJlYS7dirL1 013435157 J:J.K <br /> 6.G qt can ddmss ...;":a:•: :.;:••.•.,.• :pan reroreSNe'A'd m8s(UdlBsregl Nan msUing address)" ' ' c <br /> e'ta��f4R e, �.. .fpl2t{!ER.TSArdCT. <br /> PC BN4A(1•B VV 10t.I'A 4SZ.50 USA, :•i 'r.xi:+ +i`:i.::''. <br /> SAWA;GA 563F. <br /> Gemamwre Phone: ::nV!u�i?"'J4S•7S7nll}::;' :,. .,,: aa' :..: < ...i'^:';F:r::.s:.i"•: ... :'•.n ..,.:; . <br /> 1 <br /> fi.Tmnspoddr7:sdmpanY 11 in .. : .. n:r::r::. 'w .' : :.• - ID <br /> Geer a 1di. rf;: . .,�; ,:.::::, <br /> ... . .EPA Ndmh§r <br /> .... :::.:....:., .::.... . j::.. ,:fa-. .;::.,:.:'rLx7VECV20D'470fG.::: <br /> . 1 Tfanspbner2 Company Name U.S.EPA HJ Number <br /> FEB 2 4 2015 <br /> S.De,�peLglillrytNa .DJ4t1EfA'@§@ ...•... ..... .• ' U.S.EPAIDNumber. . . ... <br /> s�Af� RG ENVIRONMENTAL <br /> 1+7b'GRUAAK,GA 96351 HEAr_T(4 r)r-PAPTAAENT <br /> 2EEf L63515d. . . :: <br /> Fadi 's.Phone;. <br /> 9a. Bb,U.S.15OT DesplpilbA(Indudlrg Pmper Shlpting Name.Atk.6il Gass,ID Number, .: :1I Colo.grc 11:T:2fel;,.,_ ,.iR;;ynU 13.WUele Codes <br /> HM end Padang Gi up(a any)) No- Type Ouanery ll <br /> 0 �y <br /> 9f 1. NOM-fRt:P(h't1,9��?t9F3A7(J.4rJv'P_°.STF:tJt34dd7•t1JSLt.6bOtk) i` :'.. : .. '.:• . '�:^7:.": :;;.r..'T( ,.'h.a-.'�2Y::.�';i <br /> 3. <br /> 4. <br /> 14.SgticlalH p?lrtSNipions and Additional Information <br /> Vf ,ARC C:T„OVE.a _ .Y <br /> 15. GENERATOR'SIOFFEROR'S'CERTIFICATION:1hBmbydeclae that(he oements of this consignmentBM My and smuelefyderoppedabow by the properehlpping name,and am dasstled,packagsd; <br /> marked and I@beledfplscarded,and are In ali mspeas In proper condlMon for vanspan according to appsubla inlemalionaland inflom sl governmental regulations.If expert shipment and'I em t e Primary <br /> Expagar,I cattily that the contents Of tints consignment Sonform to the terms of the attached EPAAcknowiedgmeinl of Consent. . ., <br /> I wdity,that the waste inization statement identified a 40 CFR 26227(s)(if l am a large quantitygonerelcr or(b)of am a Small gasntl Leperetor N true. <br /> Genomforslofferneed P6hKCdN a — s .-_., <br /> .a 16.International Shipmencr <br /> DIM <br /> .md to U.S. ❑Ewor�'h ' <br /> Transporter signature(for expor si only):_ Dale leaving U.S.: <br /> a'shdnsponerc, �c,epto�lmokm•elb17.Tm1spatlrAtkno enla[fte <br /> 1 PdntedfType Name <br /> ^:, � Mar nor D�ay . Y�ear.;; <br /> • <br /> =H= Tranapoder.2 Pdntedlyped Name' Sign �' molm Day Yaaf.' <br /> Its . ,....-- ._...._ .. <br /> ie.Discrepancy <br /> 1ee.Discrepancy Indication Spawe.. <br /> 11 Ouentlry ❑Type El perilous ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator U.S.EPA ID NumDel <br /> 7 <br /> U <br /> u Facilityrs Phone' <br /> 18c.Signatura o ANemets Facility(a Generator Marth Day year <br /> 6 <br /> x <br /> 19.Hwilrdous Waste R d Management Method Codea(.e..codes for hazardous male Vestment,disposal,end recycling ayalsms) <br /> 3. 4. <br /> .� 20.Deslgnald FacRMOwnerof Operator:Car iessim, f mialptoltMmousmatedalswvered by the manifestexmplumbedin llem He <br /> Pdnietlrryped Name ,,' ,/ nalure Mwel Da Y <br /> iii i r°� •"� l � l� <br /> EPA Farm 6700-22(Rev.3-05) Previous editions are obe lele. TRANSPORTER'SCOP V <br />