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tseoqtclft rp-`om 00O - - 7,En=8;cYes S an Trae01i; Number <br />— 1 Gener a -,or it) Nuwb�er <br />J J—r,% <br />JJK <br />11.7151,f <br />UNIFORM�,A7A DOUS 012177674 <br />WASTE MANIFEST .3 e ?«idress I f r.1 i fere, nt a n M 3 IN. r, address} <br />ICA-taoo +1 . — <br />'Nam,apdMariryAdd%SS <br />-gGene tot's <br />. <br />4, b Piio <br />CA <br />,a, 7 d t1.S.EPA ID Number <br />6. TwPorter t txmpany 'Nal—. 00 <br />6eAYI a's <br />U.&EPA ID Number Qinpary Na i1$ <br />and S, -Le Ad -dress U.S. EPA ID Number <br />3S51 6 it 5gV,1JVt M <br />pwe�ft :I Ia. q1, <br />ga 9� U.'�� DLIT Descinotion Olciu . JN . Proper ShippingName. Hazant Gass, iD NL,—.bef <br />10. Containers <br />I,,. Total <br />12 Unit <br />13, Waste Codes <br />No. <br />Type <br />8'rid Flacki Group (if any); <br />Quantity <br />poAJ IR CAA A <br />of. <br />00 <br />J <br />14:Spe04lHatdinglnshX")ri and Xidditona" Indo ria <br />E(ZG ad a71 <br />1 7 V— <br />IS, GENERATOWSIOFFEROR'S CERTIFICATION, I <br />tereb decia above hv t ippirl <br />y re that ft writerits of this consignment are fuily and accurately described the shipping 9 nairie, and are cilmilied, packaged, <br />(mrk-d:and lab6silffiiacardemand are in alfir&kpets <br />emciper and for traitsport accci to appil i tem pmen <br />qaWe,n afianal and naficinal govemimental requialJons. If eiii A t and: I jai the Firiffory <br />E400er. I ci that the contents of this 6wsirn*nt <br />conform io th-- terms of the attached EPA kknawie#ivent of Consert. <br />certfivIt.allitne Y/aM Tr�n;mizatonst-.Wn*n!Menirledine <br />CFR 262 27fa) Iflar, amas" quarittygeneffitar) is true. <br />Gere,atcesAffe-V PrintedITYIName <br />, <br />j16 <br />G!gni Mmilh Day Yeaf <br />` i7 <br />ntemationat.Stsp <br />Import to U S� <br />f— <br />Export from U.S. <br />t..J Expo LFof entryiexit: <br />Date leaving U.S-: <br />W <br />L LJ <br />17 Tran** Adoovvle"t of k8i Of Materials <br />Trans er I Printedlyped Name <br />S g to u2 Month Dav 'ear <br />O <br />Z <br />AA <br />Triansporlef 2 Firmted/TyptiJ Nanle <br />sqni <br />MonthDq Year <br />18. DiscrePDXY <br />Type Residue❑ Partial R*cton Full <br />18a. Diweparcy QLtqy <br />Relecton <br />Ma -31 Reference Number: <br />V Number <br />LL <br />Facifivs Phone: <br />I 8c ScratUTe olflenlale F aCgiry (or GweraVf) <br />I <br />Mon'Ll-i Day Year <br />Z <br />2 <br />9t; (regi.; codes forhazartim Wi treatirwrit. disposal, <br />40OW Cod <br />19, Hazardous Waste. Report Managementsystems) <br />LU <br />4 <br />ification <br />20. Designated FacBTf Ovoler or Ofpemtor: Catt� <br />of reci of hazardous materials covered by the manifest except as noted -;n item Ifia <br />Gtinte�.Ty�Name .- <br />Month Day, yealp, - <br />EPArorm <br />oy�DUS qdit; <br />10100-22 (Rey, 705J.Prov.kD <br />L1'ry TO DESTINATI.-*%ji <br />