FROM (FRI).JUL 27 2012 10: 10/ST. 18:17/No. 7518684114 P 8
<br /> Ple a (F es t .
<br /> J a r f k JI' Je•-! a Fof►fi.Ap
<br /> 3 .J
<br /> ..1
<br /> UNII gyp@'
<br /> FORM IIA�ARDOUB.' � Gertpt�bt'tq.Nt�lf'er �Nr^,:;•it� n)0:!z�:6i'!'kr'i '��Jrf. } �,I..��..s••••=s�as 97�J vr��th6` �t f `"' a '" � :f
<br /> WASTE MANIFE8� , i 7 J 4 4 h.0- `itflvt Y
<br /> — ..
<br /> 5.Generabrq _ W id " ' t ,nRp itf T,1tjga .!a�ri (ie!Iefelor66i0e dilersiitth�J ma A i
<br /> (If Itnyaddr�s) 'lf9i�� ip<*
<br /> ST. ft CUM pc
<br /> ^G l"WAY tilt t r. nJrf tr k•, t�rki -.h' }.. r 't :? n�F r _ .•r,, 4
<br /> r�riAO
<br /> A in n d�s`,:if•r6 '�: '.r•.• -'fi:;i:flC'1
<br /> Gener•atols Pllone> aa1�r�
<br /> 6.TransporWA:Ca!n*W�NAI!ie 11.8.
<br /> awdsuwrk
<br /> 1.� A'Ks - t. tt •t,(�: r:' Y r. .. M��y�.r .1 ..;.., .,.x• t'+±anj-
<br /> ..r - :r. ti:..pr Yn+WJI, ,.'4
<br /> 4t'
<br /> T
<br /> Transporter T Company Name U.S.MID RhmW
<br /> 'Vn+; Will•l„i,,. U.S tpA�titmt!er - . .... '
<br /> ♦may ,�,��/�y r left '' r. '{w- M4451 1 .
<br /> C •U
<br /> 1ME!'1t?Y'$�•'AdC'1Fi'IE AtJt�>!�Pr.!�!�`K '.y 1'f i .,.�•,'.. . s"N 4.'(!�i f!"•Sit _ r
<br /> Faeil' a Phone: _ -
<br /> ga. W U.S.DOT Descnpbon(indl" /1. ��.�v��.yy..". .,
<br /> } ��, ���• tQ.. .: :1.17 TOW; :4ryZ.,yr,rU „F .`fa ,.r,. i 0-^.;f'•':
<br /> HM and P"ng Group(,'arty}j r 13 TIV�EY'tro�e�
<br /> ply _ No,- �ryyp�iOmntlty+ 4YtNd: r. r It 3t
<br /> t. I (jL`' {'11!li OtZBEiT . . .4 '. A r.. ,.',.`1(e�:ur!J :1•; irrF,n J f ,
<br /> Stn. ,1 T?iR
<br /> 0 CC>w�,�IMN"i+lT�V WKXL) l..,
<br /> � .._ ..,.. .!_,.. .-......� ,. . .. .. ;:•. ,.. ,.. ...,�.;c! +t0-u 2,";n, ,a:? ,tlifal::,.rrl!•tr.v :.v. '
<br /> 3:'..
<br /> rss?-.,.z, •:a' - - `i.. y; 4r.:, ''A!
<br /> 14^ pecialYiandlinglnstnx�orJ'sardAdtli6ona InfonFlaBdri r
<br /> A68MMWPAMcOnrr TW%VO # W t; IIII11Iwe.APPROPMATIy�llc�i I a te: -N.
<br /> .. .... �` Ct'J:{1 i;}-t15..�.... ._,. �.._ .']I1__..._. ....,..•.•:1',',Va::,Y_`.'.iui 1 ';i. .�2:
<br /> i3. �ENERATBR 3lOFFEROR`3 C RTIF1CATiQNt'I�ieiehy declare that the'contar!h of t}iis consignmerd aro fully and acaxately described above by the prgppr shipputg name and era deawf+ed�p�ackLa�8gdr�r .
<br /> marked and labebdlptacarded,and arum per al respects in prooad bw for transport aocordoW to a*cable inteinatronal and naboriaf governmental MR406aie H eJcpoA shlpitterdard I am the
<br /> ' Fxpor4ar,+I cerUrytlwfth9:tontarits of.this:tdesignment canfarrri k,ihe:temrs'ofthe ettadied EPAAdcnoyAadp�rtenl of Conserd. tr^� .• ,;sla:_w`.:_ .'3cA._ ,�.2..., ••f •.::;::cJ :e,is
<br /> I carWIhat the waste CFR2fi2�7(a);(ifl:em 4 40e Quard y 9ener#r)or(b)@f l am a suwtl gi!pMNY9enefa(at).illfie:;_y,. w T+: _. r,_ !
<br /> Generam�sC)Ifa sPkNedfflipedName f -" T ( Sia
<br /> F rr :: t '' T - ,' J fr +: '.t ..,1{` .i,4
<br /> .+ 18. - to U
<br /> Ipmet!ts rt from U.S PtiA eF. - in r rU
<br /> E Import .S. El Export enby(oJdb
<br /> z
<br /> Transporter sigrmhJre(for exports only): DoW*t US: r 'i: .>.. -.tic"r,
<br /> w 17.Transpo!terAcImowlecign ert of Receipt of Materials
<br /> T P1 PnritXI/T M Narhe I . SQtmtJJ r MollHi f
<br /> z TraJlspater 2 StgriehJre Mon01 ry Year
<br /> t 6 Dl!{CrerlanL]I:' 1" �. - :.'. ; ::[,.(,,,•l�,
<br /> I
<br /> 1 Be.D(saepef"InC1104 J 5pece n'auanuty Q Type ❑Residue ❑Partial Rejection Ful RlJar�lOtj" ;l!
<br /> i
<br /> MantlestRelerenceNu bet
<br /> I )Gener
<br /> o
<br /> 18b.ARerr,ate' adr r *r U.S.FPA ID Number !
<br /> n. N ' ..
<br /> 49`' .•i
<br /> Fadlit)/9 Phoria; .
<br /> LL, 18c,S6ailite dfAltemate Fgc!W(or Genetator) Mad! can
<br /> Z
<br /> S2 1Q Heaadoue Waste Report Man ement Met W Codes i.e.,codes for harardoiu"stgtrostrnent,d' '
<br /> � ,. . 0-9. (. ,_ . _ tsposai,and ragd!ng Systems)
<br /> 1. 2. 3. 4.
<br /> • S
<br /> 2O.Designated Facility Owner or Operator.Cerfllca8on of receipt of hazardous materials covered byte rnanifest.mkoW as noled indtem 18a f:
<br /> Prinba&Typed Name gnetd,ra,
<br /> EPA Farm 9700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL 6000.
<br />
|