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Please Pint Ortype (FwMdesioned form on etas (I7..vmN n.row,ae.i <br />cu ryAUu I r IV UESTINATION STATE (IF REQUIRED) <br />. Graralw D Number Forth Appnoved. OMB No. 2050-00.99 <br />UNIFORM HAZARDOUS 2. PagBtd 3. Fmergenq Response Phone d. Manileel racking Number <br />IFEST _ On 0069708 D w T <br />7Ge�atcrsNam <br />e wd Masvq Adtlraaa Generatofs Sire A00riawil umeremman maing adadomi �sjl.mpany <br />Name <br />U.S. EPA ID Nanber <br />7 TremPoW 2 —m y Name <br />U.S. EPA ID Number <br />S. Designated Fecaily Name acid SYa AdhaL6 <br />._ us. EPA ID nwmde <br />Fade sPhoni. <br />ga, <br />9b. U.S. DOT Dawnpiampuiadn; Prgnr Shipping NenO, NezaN Class. ID Number. to. Conuinars <br />MM <br />and P".,,g Groep (if any)) mi. Taal 12, Una <br />NO. Type Duanary wuvd. <br />1. <br />Ig, Wesal Cases <br />W <br />tD <br />- <br />0. <br />4. <br />OI 577..5 f <br />14, pegslFWlding lrlswclant antl Adtlibonm Womalan <br />t5. GENERATOR'SNFFEROR'SCERTIFICATION: Inarabydeplan, mal me Wnsmb of lhamiaynmanl are Nlty and accurately deaopetl above by me pmpasalpphg name, ad are onamaed. pwksged, <br />marked and lahaladlpiacarded, and are n el retpecm in proper onEmon la <br />On'llwlt A=rdng to applecabte mn&nwimal and national fimmmentel regulapons. II exPal shumem ars I am pe Pnvmy <br />Eapunec 1 canilyPat Pe"'mm"a of mis c `flnmenlcanfoan m me hems of ma allaarec' EPAAcknavledgmanl <br />of Consent. <br />I artly IU me Man mmimmadbn statement idenbied m 40 CFR 282.21(a) IV I am a large m nmy geranlwSa(b) R, am a smat WanWy peneamr) a nue <br />Gmastor'o0gelors P' y etl Name Si <br />Ma�7lth Day Veer <br />2'-- rrtA 1i t. <br />" <br />2zrr 47� <br />F 16. Inlemaaonal hpmenm r''� <br />LJ Import m US OE .5 Pon of aloylexd: _ <br />z Tmsparer sgnamn(Wexpons only): --- <br />Gale kavlrg U.S.: <br />17. TWWOrterAclawMedgmanl ofRecmpt of Mafense <br />mrapaetertp'-'�-1\te1crryped Name <br />aWn L <br />orim Day VaBr <br />•Lte' \ t( V1kY 4 <br />d' <br />iensportar2 rmyRYPf Nams <br />iplalure <br />Manor Day Vear <br />} 18,onclummy <br />18e. Dbaepancy Wicabon Some 17 OType ❑Residua ❑Paa(®I <br />Rejeram ❑Ful Rapcbon <br />IWAIM�Iafe Fa aoy for Gan emtary].Z/t.-_t Manilasl Refe Number: <br />✓ .a r.. <br />-i <br />p.J'. ... <br />c"7C f:N (^j ('!'W �^rE Ti: •:J� � i ... UJ_ _' w U.S. EPA ID NumOe( <br />r4i Fa<iitys Phone: a)'r —,91 %1 '^.': <br />lec.Signal Animate Facially to Gam"otj <br />" <br />Monm Day yaw <br />y <br />Ig. H822msu&Wae b Ramon Marta Il Memod Codes (i.e.. codes lforhammam8 vt MtNatmeml, d'6posal. said legdimg"am$) <br />0 I <br />1 20 Designated Faclay CanarwOpem o Cm,,,abon of n apt of bsaaNeus matetslocovered by me moored as cam as Wed anBen 180 <br />wn yped Name igtahae March Oay year <br />PA Form 9700.22(Rev .3.05) Previous adifions are bbsababa <br />cu ryAUu I r IV UESTINATION STATE (IF REQUIRED) <br />