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e print of type. (Foran designed for use on elite (12 -Pilch) rype <br />1. Generator ID Number <br />UNIFORM HAZARDOUS �y,r�.00 <br />WASTE MANIFEST a WW, . �y'V <br />5. eneratofs Name and Madm ddr�,s N'i`�' <br />�,l ioig you r jj rl=�caLd�, <br />i s Phone: <br />96. U.S. D0T Description (including Proper shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />J <br />U' <br />SAEPAID <br />( rI Ah <br />Q. Total 12. Unit 13. Waste Codes <br />Quantity WLNoI. <br />61 <br />U Impart to U.S. <br />s only): <br />of Receipt of Materials <br />18.Discrepancy <br />18a. Discrepancy Indication Space <br />Quantity Type <br />Ides for hazardous <br />...�e.,n,,.... rwxinl of hazardous materials covered <br />20 Designated Paullry uw - T+N -���-� � - <br />are <br />Pod of entrylexit <br />LJ Partial Rejection <br />18a <br />i< 1 d, <br />Rejection <br />W io- I ►1 I o- <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRI <br />5 ,V,03 /Hfvct�/r`-r---�•, � o! Z <br />4y a/v 93 <br />j� — <br />6 <br />2.cs C t� �• DS Ale C wv) pllN�,c. <br />l'U7 <br />-- <br />uan�A�3u'lolu.xl�rc. �SC�5l.v5�/i�lxy.>s <br />-- <br />Cliff <br />�CN.pJiuJ3/6./ D <br />/g9z'p� 00 <br />../lG <br />14. Special Handling Instructions antl Additional Intormalio ,, C N [^�J, 00 P (O f'7 />c N)r /tom n 3 <br />l Ciw �ool� ,4L STD * Y /� <br />2 <br />`/ C-11 ZYoG 2z ik t -r <br />ng name and Is ! <br />15 <br />is io propelraolre oon fort the rttransport according$ of this comgto applicablriment am e ilnternational ay and nd alone governmental regulations. ife port shipment and l am the <br />GE <br />markedzndlabeletlFEROR'l and are all0r respects <br />Exporter, d abelthat the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent a atoQ is True. <br />he contents statement identified in 4o CFR he terms <br />Exporter,(it am a large quantity generatko,�',,am arsqutity g <br />that the waste //7� nak22N"'/I <br />U Impart to U.S. <br />s only): <br />of Receipt of Materials <br />18.Discrepancy <br />18a. Discrepancy Indication Space <br />Quantity Type <br />Ides for hazardous <br />...�e.,n,,.... rwxinl of hazardous materials covered <br />20 Designated Paullry uw - T+N -���-� � - <br />are <br />Pod of entrylexit <br />LJ Partial Rejection <br />18a <br />i< 1 d, <br />Rejection <br />W io- I ►1 I o- <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRI <br />