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Please print ortyps, Fonm deslptted for use on elite 12-pbh ewriW.). Form Approved.OMB No.2050-0039. <br /> UNIFORM HAZARDOUS1.C,ar►erater ID Number . 2:Page 1 of 3:Emergency Response Phone nlfest Tracking Number r ��//'' <br /> WASTE NAN]FEST i,jamimjvq JJK, <br /> 5 Genaratara Name and tulaSngAddress Gerreralors 511a Address Of03 <br /> dllmrentfhan mailing address) <br /> CIT`,°7� mtxTCN.!}df.1Nl+Ctix.iJtiu-13C-s 2144 f�ON7 AA*: [KIM . <br /> WIRD QRIV(' <br /> Cssnerators Phases:"' <br /> . .:: .. . - .. . . . .....- U.S:EPA ID Mrm6er° - .. .—.. <br /> '6rTreaepollar 1 Campan <br /> RM.A P=Mop +idiclEWAL WACM IlMr OA4]tY4A0f'S.� ' <br /> 7.Ttansporler 2 CGnpairy Name U,6,EPA ID Number-' <br /> B,Designated FacE#1y Nara aryl ShsAdcrsse U.S.EPA ID Number <br /> .f1�ifA� ,�I!?£#Fdb11�+TfAI.,Ei�l?►f>.�F�'ihf�., G,> 3Ad£k1'.596 . <br /> T'9fieAr1Et'1411i1,C� �. <br /> FadEit+s Phmed 31�- Y 167+17 .'.. ' <br /> 9d Bb.U.S.DOT Pascrlp m(indudW PraperShlppkv Name:liexard-Gaes,10 Number, .., -10.Cordainers 11.Total .. 12.Unit. 13 Walla Cotes <br /> HMNo. <br /> and Padc>rtg Group(KanYU Type Q4entity NfLW <br /> 4• r�•E?!t�lcA:l'� ' [l��trl =iyr1�l��tt3tQ ,: •' - : •.'�'� - - _ _. <br /> of . . rCl 1�'+•., '��;° i' ;. <br /> W - - <br /> - - Yl . . <br /> 4 <br /> 14.Spesisl � Inabuc6orm aridAddltEmal IrdonrraBarr,"': `` . . .-... ..- <br /> I AfiIOl.M.7th BE 7RA.MM `. Fifa S�'i>11f 101 <br /> 15. GfN0ZaTOR'810FPER8R'SCFRIIFIC . <br /> ATtON I hereby declare Drat the d�rrlanls ofttds oanslBnment am end gimuratey_desgl4sdabode bythe proper stllRpping nertra and era c�ssi#ed t 9� <br /> marked end IabekOlacerdad,and are In a0 respects In proper ocrttpon tgrbdnsport ecoor&g to apglfrabis bstematiwraland nationalgovemnerdal reguladona,3 err)ort shfprnant end'I agi the Primary. <br /> E porlg I mftffiat the ooatorb of this conslgnOeO aardon-to the tames of Ore altKbed 8PAAc wMadgment of Consent <br /> I t thattha writs ndnhntzdm.atetenient.lded tad in.40 CFR 23227(5)Of I am a large quenYdy generate)er(b)(FI em a smd quamMy generator)le.bus:- <br /> Genera4oedOffemr' PrinthdrTyped me 5 tore Month Day' Year <br /> (j I <br /> rig <br /> 6,49rFr7powsImport to U. 0 ExpDd'fmm U S PoR of tryl+ <br /> Ttansporlar.algnstrire"(for*ortscnly): ; `'Oath U.S <br /> 17.TransporlerAcknow>adgnrant of Raoelpt aF Matedcts <br /> Transporter 1 tedfT ed Nemo 3i9 �Y <br /> .r re �. i. N4eitlr I YB8< <br /> Hoff( Pa1r . <br /> lea:Pisarepancy indwkn1 Fue mi n <br /> • Q Quatrffiy ,.., ._ ���Resf3te OPartlal Ra n Re <br /> l. <br /> Manffest Referai4s Nrantrer <br /> 1&-Mernste Face {or C:enersdgr) U.S:EPAIA Numlfer 77r <br /> sat F2dely 'Pha7ie: a r r Cn <br /> Q lee.Striae blAflefrtErte (wGie s:,i e .. .[ t _ _.. I•IP_llitl Pay' Yom. <br /> y19.1 pnrdotp A%"Report ManagaMed Method.Codes.(Is,imdesfru hamrdotiswastotreatment,disposal,and rsgd g systems} <br /> c1. 2. 3. .. •r . .'r•F,F 4 c .. .,.. 'r, ,.- r -:r,r� <br /> -- <br /> 20,Dedgnated Fedity Orimer or OperaW'Cerb9rat an of reeelpt of hazardous matsdfals crovered by the dnenife except as noted In Item 188 <br /> ypedtfart� Signature r` Mwth Year <br /> flPAFonn8700,22(Rev.3-05) PmvlousedlDonsamobsolets. GEN ERATOR'S)'€IVITIAL'COPY <br />