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v ry1@m0f'3 ndUT ,?,r„ .wleacn_�•.n��a e ,.I Ead,ng has been issued nod s nn! <br /> a ev,r pucnalro.cevenno the erooeM <br /> Sh,nnrr Nn <br /> Please - , <br /> UN FORM IFome de,y-eed for use on elite(12-pdch). <br /> �+ WASTEH Riol 'Um+eraw,1D N,,1, 'Ypewnter) <br /> s (MANIFEST ea�.„ <br /> ` 5��'-' , / •r r-.e. 7e 1 M t Emx'/ency Re101 Pt". Form Apprn Jen riMEi N„ <br /> - x M 1 I T ckln{a Number <br /> -�� J 5 FL <br /> dre.s p <br /> AdE <br /> Off- <br /> 'al Y (• enlran ae� <br /> eP i C i <br /> yT <br /> EPA ID N—„ \T, <br /> 1 <br /> 3.eDes9navn Papery.Nan a C 4c,1• -. U S EPA U <br /> C 1 •rt�.�t.J ' ll <br /> C,9,z� F� , + • J, ' I C� r � t � � <br /> Ya 9b US DOT Oescnpaon bnOuc,a SP <br /> ,P",pl'K:9 Nance Nezard C!as_i, _ t r <br /> N N. and Pau g G, ! i <br /> P 1nf / <br /> Lv 1'.7i 1 j 1-r.? O N,am[cr. ?J Comae ers .r <br /> o!a <br /> 1° Ti, �a.011 .VI'JJ! Nw,,c , <br /> 0 z <br /> (n LU 1 � <br /> N (n �1 <br /> (D <br /> 4., v 0 <br /> 1 C Speco'Harln,Clons and Addnwrial lntonnaoon <br /> J)IePpRGVf( ft _ <br /> 15 GENERA7 'S/OFFEROR'S CERTIFICATION:Ihereb r 5� <br /> Cn <br /> marked and labeledr 7 d?cWre that the contents of I)IS corsignmenl are luny and accura!Hy descnbed,_c.e c re , ��✓ "4 f�_ <br /> Pthe Oche and are In an respzcls m proper wndibor,for transport accord,ng b apylicabie internatwral and novenas , p'cf,,snpong ame,and are dasse`'a!d,zacka d. <br /> OeMtir t I t the W <br /> the <br /> Intents of'his consignment wnfonn to the terms o'the allached EPA AckroMedgmenl of Cone.^t �verr�menl�regulations.If ex pnm rr <br /> ! rA-!ha!the waste mmun,zation stalemen!identified m 40 CFR 262 27(aJ pl I am a large PAA s 'x"e0J am I am tree a <br /> Genwalor's .er s noted yped Name g Y generator)or lb)IJ{I am a smac�,rancty xnerala)es.rue <br /> r-h gna <br /> tom.//r i.•I- ,';;. _. �i <br /> M <br /> -u 16 International Sh,pments Y 1/0 <br /> l V 2 ❑Impon to U S, <br /> X Lansponer s,nature(tor exrts xl r � ! , Export from U S Part of entryieal � -- <br /> 17 Transporter Aok leavin U <br /> � nrnvledgmerrt o!Rewipt of Date <br /> 0 Transpbner tPnnle Rd?yped Name <br /> ?'t r,.! /Y�6 _ f, /r'(`('J i gna <br /> tn <br /> 1yti/1:i').t_i.J y;rth ay zar <br /> (D < Tran•Do!ter�2 Print yped Name <br /> j - y nail re <br /> year <br /> fir <br /> 0 1S D's{Tepancy Com , t <br /> IBa DISIMpancy Indicatron SpaceII (� O <br /> Ouantdy, L 'Typt Residue <br /> 0 ❑Partial Rejecben ❑Foil Re;zcbon <br /> (7 Ift Alternate Facllry(or Generaiorl Marded Reference Numa r <br /> 0 'J S EPA ID Numbar <br /> LL Faaht's Phone. O <br /> H18c Sgnature of Allerndte III(or Generator <br /> ZViorth Day Year <br /> 19,Hazardous Waste Repurt Management Method Codes(10,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O <br /> 2 3 a <br /> ( g D <br /> (D 20 Designated Facility Osvrwr or Operator.-CtNtl6ralion of retelpl of hazardous materials covered by the manife;l except as nosed in Item tt3a <br /> Pr `ypad game `i. "7 _ _ ,_ Signature <br /> EPA Forth 8700 22(Rev 3-05)Previous editions are ob lila. f <br /> DESIGNATED <br /> CD <br />