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08/15,121313 14:'20 209529' -°h FOYETT (4AREHOUSE PAGE 111'13 <br /> Pfd&8 pent <br /> Form Ap roved-Otv1B Nb.2050-0039 <br /> or typo-(Form desl red for use on elite(12.pkh)typewriter.) <br /> 1 Generator.ID Number L>age 10 '-;ne a,ncy'Response Phone 4.MantfastTYacking Number ' <br /> UNIFORM HAZARDOUS �r �+. S `_{K <br /> WASTE MANIFEST f�.' " �r � ' " � 2 vY <br /> Generators Name and Mailing AddM89 y .. Gene;at9'a y to Address(it drtarem than msec g address) <br /> Generators Phone- , x'7'3'- <br /> 6.Transporter-I Company Name us.• , <br /> * 7.Transporter 2 Company Name U.$, PAID Wmber <br /> AUG .21 2013 <br /> $.Designated Fai4Iity Name and SltuMdress <br /> U-8.. AtD Number . <br /> r�yfr((�'�� «p 4 Jq .�g¢�� ' EWRONIV(ENTAL: . <br /> iti<47ae�V ith A veY . <br /> 119t °ARTMENT . .• <br /> Faoil(ty's Phone: '1 rd5^�°r40 <br /> 9a, 9b.U.S.DOT Description(nciuding Proper Shipping Name,Hazard Class,tD Number, 10.Containers 11.Total 12.Unit 13.Waste codes <br /> HM and Packing <br /> Grrouup(i(if any)} Type Quantity WiNo1. <br /> c 1/t!�/1':.✓.ff�r���l�/..����•'`r''`-�• ,J' '�'`�'�✓'j���'�•� j �_ � 'k ,�✓ ,�y� /�,r�+ �r�r/ <br /> LU <br /> a. I. <br /> I <br /> d.Special Handling Instructions and Additionalnformation -ez <br /> The GENERATOR'SIOFFEROR'S GERTIFIGATION: i hereby declare that the cantenta om'Jfs conslgnmem are fully and accurately dczcribcd above by the proper shipping name,mrd arra Oar�aKd,Packaged, <br /> marked and Eabeled/placarded,and are In all Tegpects in proper condition for trampon a=rding to applicable intam peal and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I.Certlfy that the contents afthis conSigrmment=1017m to the temre of the etlachM EPAACknowledgrnent sent /' <br /> I Certify that the waste minimisation Statement identified in..40 CFR 26227(a)(i`l am a large quantity generator} )(if I2m a gms1 jsntity generator)is true. Month Day. Yetir <br /> Generator's/Offerors Printed/Typed Name <br /> ' w. <br /> � i6,inte t aiShipme e-' s Pa of en (exit <br /> F LJ <br /> port to U;S. t_export a�� <br /> z Transporter signature(for expoft 0*)! Dat tee nngg <br /> U.S.: <br /> w17.Transpo"Acknowiedgment of ReCjelpt of Materials <br /> Tr-jnepoter 1 Pdnted(fyped Namo 3i2natura Morth" Day Year <br /> CL 1 ' . i�1 ° ss. t- <br /> 17111 <br /> M TranspoRer 2 Printedffyped Name Signshra Month Day Year <br /> Q <br /> 18.Disrrepancy <br /> "Itis.Diacrepsniy Indic2tion Spa e p �jusnfitY ❑Type _I Residue ❑Partial Rejection Full Rejection <br /> - ?AariteSt Rerer2nc>:hh�mbar. <br /> U.S.EPA ID Number <br /> 1$b.Altemate Facility(or Generator) <br /> Facility's Phone: Month Day• Year <br /> W 18c.Signature of Ahem Fackity(or Generator) <br /> Q <br /> a <br /> 19.Hazer dous Waste Report Management Method Codes(Le.,Nd Es for hautdoliS wagt trestment•disposal,and recycling systems) <br /> 14. . <br /> 35 <br /> 20.Ovilgnated Facilitywner pr Operdi0,:CertlflcsBcn of receipt of haze bus m3tef !s mvercd by toe roma eycept as rasa r I Ism 1Ra <br /> P ntedlTYPed Nama - 8lgrsmre �-- .. <br /> Fdontn Day Year <br /> EPA Form 37402:{Rev.3-07 Previous itions are absolefe. 'r �ESII�{�IATED FACILITY TO QENERA1Tf]R <br />