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~ - <br /> Missing Manifest: Inspection item n5 <br /> Pla2se print or type.(Form d6zii ned to.,Use on e ite(1 2-pitCh�typpwhter�, <br /> MbL <br /> 'One INu <br /> UNIFORM 1AZ0DOUS to?ION mber 2 Page I of 3 Emer Form Approved.OMB No.205C-0039 <br /> WASTE MANIFEST <br /> riper <br /> 5 Generator's Name and Moiling Address j <br /> re <br /> 38 SKS <br /> =S JKS <br /> AM <br /> Gonlefatoe�Phone: <br /> U.S.EPA 11)Number <br /> 8,Oesignse Facil Na.. <br /> US ErA to Wrobe, <br /> go. 9b.U S GOT Chescriplion(includmg Proper Shipping NArna.Hazard Class,ID Number. <br /> Hki ond 1`11,06ng Group(W any)) 10.Containers 11,Toter 12.Unit <br /> (x No. Type Quan0y W1.1vol, 13,Waste codes <br /> LJ <br /> RECEIVEL <br /> MAR 2 7 2015 <br /> 14,Special Herding InAlrWIrons a Additional Inforsnal.on <br /> 15. GENERA R CIFFEROR'S CE <br /> hereLy declare that the contents of tH$consignment are My arid accurately described aboye by the proper sh; n3me,,W are classified,paeka*, <br /> marked and iabe!RdVaicarded,and are in all raitpoW in Proper Condition for transport acocIdIng to OPPI-ble intemali"I and national governmental regulations.If export shipment and I am the Primary <br /> ExPOrtef,I Oer*that the conse is ofthis corisigrimprit conform.to the terms Of the attached FPAAckrowedgment of Consent. <br /> C,;_I certify that the waste minimizanUOIII StOlOment identified in 40 CFR 2EZ.27(a)(if I ama fAT6 0antitV generator)Ot(b)Pr I am a small qUantny generator)16 tIU0. <br /> Off <br /> "'r month Day Year <br /> Ifi.Into I Shipments <br /> 0 Import to U.S. <br /> Trarsporte,signature if— Export from US, Portafentry!eXit: <br /> UM17.TnInSpOrkir Acknowl Date leaving U.S.: <br /> j edgment Of Ramps Of Maleness <br /> re IrarspOr,*1-',PnntacVTyPad am, <br /> Sqnaftire <br /> Month Day Y,or <br /> Sgriature <br /> P Month Day Year <br /> f 18 Di pancy <br /> 188, PSV/Indication EI Quantity Type Residue Partral Rejection Full Reject;on <br /> ce Number; <br /> U.S.EPA ID Number <br /> Li <br /> 1''Woolh Day year <br /> 9,Ha,,adobs Waste Report ManageMalt Method Codes(i.e..cDdPA to rarclous waste treatment.d <br /> 14 <br /> fin M Name <br /> Yea <br /> INS editions We obsol�le. <br /> DESIGNATED FACILITY TO GENERATOR <br />