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Please ' or MA. Form deal ned for use an elite 12-pitch) G83S97394006 SC PPW %",I.. <br /> 1.Genxaior ID Numlwr Farm Approved.OMB W.2fl50 00n <br /> I�AFORM W1UiRDOp$ 2.Pape 1 of 3.Enrrgrncy%mm Phom Nundw <br /> WA IM 11A11�W CAC 0 0 2 16 7 3 2 4 3 (800)403-W:W F L E <br /> S. Name <br /> V=MCMA W Wo Po an 40" 44 WON VWM at <br /> Qenerutorsftw MM)89"JM ATTNAwmwMWwM 9hmW jOfi tQA952D3 <br /> Ohm 1M*Or wft 5mnb *Ina u.s F�AID Number <br /> MAD039333360 <br /> U.S.EPAI iVumber <br /> U.S.EPA ID Number <br /> Joe LLC <br /> Ij■njOA8, CAD059494310 <br /> I Phone: Wo9)4414M2 <br /> 9L 9b.U.S.DDT Deerxiption*WN Proper Shipping Name,Ha=d Class,iD Nw*w, 14.containers 11.Taal 12.Unit <br /> HAI Padd�GrDup Ca any}) Na Type Uuerrtlty LAAA. 13.4Yaste codes <br /> ' I=MM HAWDIM WASTE LWDS,(WATER WITH <br /> TRACE BATTERY AIpD) i� <br /> 2 <br /> 9. <br /> 4. <br /> .Spedd H and <br /> 1.CS51EB91B . <br /> 15. GONWATOR'SIpFFEVAM CERTWATIDN:I'hwoby dsd m ft the wotanta of Vb*molgmrrd aro*and 2wxatety deecdbed shots ty 8r proper s*oV name,arrd are da WW,packaged, <br /> MW W and kbdWpkwdsd,and are In as reepsds in pmpar DV dit for trerrpat aaoordkg la appkatie kdenO"and mMor d govensnentel re9tdaaans.ff emacd shiprrant and I am ft Primary <br /> Exporter.I wrefy 9tsNhe comm, of fhb oorrlpvnmt conform iothe tomos of the aaadrd EpAAdwoWW W cfcomoK <br /> I art itis waab minimiMft etakmnd Idmdlllad in 40 CFR 262.27(x)(if I am a bW*W*eN04 or(b)(9I am a wa W ty gemmo is kw. <br /> Ei Impod to U.S. <br /> ❑Export flan U.S. Pat of antryFexa <br /> Date Wft U.S.: <br /> 17.TmmpwWApnortbdg and of Receipt of Mftlab <br /> monin Ow yew <br /> $ f? 1 <br /> 19,Disaewq <br /> i8a Dbaapaney brdCeion Spew ❑ Y ❑Tjlpe Q Reafdue ❑PMW R"cdon ❑F.1 RWC§Dn <br /> tAarrNeM Number. <br /> 19b.Altemela Fec✓>Ky(ar Generate U.S.EPA 1D Number <br /> F Phare: <br /> itis Siprrehae ARernate F-1ky(or Gw4n*M Pr7i Day Year <br /> 19.;•lezaMmus WMW RqM Merrgernent MMhod codes(I e.,wiles W ha=ftswaste 4e0ent,drspwal,and re*"""VMS) <br /> 1. 2, 3. 4. <br /> Mn <br /> 20.DmtrmW Facky Owerr or Opembr.Ced ikon of moW or hatsniots mat nk covered by the WOW so*gWobd in hem 18a <br /> Morb Day <br /> Gtn�u10 11-71 <br /> EPA Foran 8700-22(Rw 3-05) Previous editions are obsolete. DESIGNATED FACILITY T4DQN STATE(IF REQUIRED) <br /> /! 1t�atIBRR /d[fllq�tA1iM•IMftilpt{hI11Ng191�{+M/ eneoF MI�I��, <br />