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u.J.tPA lU Number <br /> P 4 P /n(v us CAR aao 777 sa l <br /> I. nsporter 2 Company any Name Name <br /> U.S.EPA ID Number <br /> B.Designated Facility Name and 8de Address <br /> q of RR^/C C�ORUO�/q� LAG U.S.FPAID Number <br /> RV AD <br /> Fadlity's Phone: A144 O COR.OoUA. �4 957112j (910) 3,5 09,-p N& L/8o 4782 IS3 <br /> 9a. 9b.U.S.OUT Desert ' (including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers <br /> HM and Paddlg Group(d any)) 11.Total 12.Unit 13.Waste Codes <br /> No, Type Quantity WtNd. <br /> 1' ZfnldO/� �ASr fE�bn°oGcn/ y�eoxiDE, aoo/ 60,02J4! <br /> X Aea(auoi vaaa,(�%ds S PG 0,,& TP 0500Lit <br /> G j <br /> z 2. <br /> 4. <br /> 3. d <br /> 1 <br /> 14.Special Handling InsWctions and Adtlitlonal Infomlation <br /> 98/) PRO &91A3/7- as Ay aso e'4u-04 Tnr,Fs) <br /> 44FAR; APPKo w7Yc71/L— LrI 7.JG E4bl0lA T �08 /aZ- /S'03- OOa/ - 1J000/ <br /> 15. GENERATOR'810FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment ane tW and accurately described above by the proper shipping , <br /> marked and IabeleNplacarded,and are in IN respects in proper condition for transport according to applicable international and national govemmental re are classified,packaged, <br /> guletione.eexgname, <br /> shipment and and and I am ere PrimaryExporter,I Certify that the contents of this consignment confaml to the temis of Bre attached EPAAdmowledgmentof Consent. <br /> I centtychat me waste Minimization statement identified in 40 CFR 262.27(a)(111 am a large quantity generator)or pit m small quanfitygenemlor)tsbue. <br /> ane 310fam s at ype erne <br /> ria ne <br /> ,7( Jtr'C� �ZoO�,'M'rl'N( on y ear <br /> X 41 <br /> / , <br /> � 18.International Shipments 0,5-1 c❑ <br /> Z tlapart to U.S. ❑Export tram U.S. on of Why/exit <br /> Trans orterel naWre for exports nn Date leavi U.S.: <br /> W 17.TmnsporterAcknowledgment of Receipt of Materials <br /> Transporter i Prints yped He.... ignature <br /> on ay Year <br /> � n1 A- <br /> z OS�D iS <br /> Transporter Pdnted/I'yped Name ignature Mon ay ear <br /> C <br /> r <br /> 4. 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ <br /> TYPe ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 186.Alternate Facility(or GenemfaManifest Reference Number. <br /> ) U.S.EPA ID Number <br /> J <br /> U <br /> a <br /> a Fadli s Phone: - <br /> W 18c.Signature of Alternate Facility(orGenerator) <br /> Month Day Year <br /> Q <br /> Z <br /> CD <br /> FEE <br /> 19Hazardous Waste Report Management Method Codes Cie.,codes for hazardous waste Ireabnent,disposal,and recyrli ems <br /> n9 rid 1 <br /> or Operator.CeNfication of receiptomani est except as nosed N Item 18a <br /> SignaWre Monm Day Year <br /> EPA Form 870D 22(Rev.3-05) Prevbus editions are obsolete. _ <br /> I E331G1N)r,E'IF :;it_!'!r rscT)*vr a� e <br /> -_ 7., . I„�,ns�,<S7AfE(1. RtQalF"_Gj <br /> HLIUEAVEL <br /> MAY 13 2015 <br /> NVIRONMENTAI <br /> 'ICA-TLS ,ryC4A OTIACAIT <br />