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048266-13 <br />Pimere mint a I" (Force dardoned for use an elite (12-citdil hanowriled.) <br />165.0252 <br />Form APProM. OMR No, 206()-1 <br />EPA Few 8700-22 (My. 3-D5) Previous, adIfions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZAROOU a 1 1. 13mosoveor ID Number <br />marganq Roatiomesir Phone <br />4, Warren it. a ma U <br />DAT <br />WASTE MANIFEST I <br />%B7'?`) <br />1517 <br />6. GawmA>ra Noma and MolingAddrage <br />PA 115215 (721114H -386h 11kay t", ism inwiti-na <br />50niNaWl, 1`1*110: <br />e. T, a. To nor I . Cone UAIEPAIDNovedger <br />Company blanne, <br />Cxritury I'latilat9c.ment of Caii`orn a., P CA �0021Gtii <br />7- Transporter 2 Company Nonno U.S. UA ID Wages! <br />EIIIV14hi SERVICES CIDL92613433 <br />8. 00sitinahad Facility Noms, aM See Address L U.S EF20 Number <br />'US ftftlojp gm�rI?' <br />t;q §5, h Piles S. of i1patity P.O. fox , M <br />Far* 'Iftart: 21felfAV, My IlStO MS' 553-22V2 4VT330010060 <br />9b.US. DOT Denodpage Snotudis,; Protean ShIppint; hung, Hazard Class, ID Number. <br />10. Containers <br />11, Total <br />12, Unit <br />13. Mass 01id. <br />No. <br />Type <br />HM <br />Onscov <br />VeNd <br />fo; <br />a <br />4, <br />ASH SOKi i-20630 1IN t._PT <br />19W AW K <br />15 GENERATOR'SiOFFEROR'S CIERTIFICArDil hereby declare 1hatthe =fonts dads consignment aro fully and accurately described above by has propershipping manes, and anipassfiml, packaged, <br />legged aid abomeliplaca I adcau a I ned we in all "gets In pactaof cordil for trarmixot according to applIcIIthe International and national goverringantel Mutation$. If excmd shiliftreank and I am In. Penney <br />Elparsar. I entity that do, asuagoo; affids consipment conforn, to the him of the caseload FlooAdmovattinnont of Cement. <br />I cortify that he areas nimleroalkin staterget ["Red ke 40 CFR 26227(a)(If I am a " quadlity gaugglor) or 0) tit I 00ra wavary Wander) is bug. <br />I'didcliTyped Names Sagramure <br />Noun OW Year <br />16. Intermediated siripmends ❑invart to U'S❑Export too, U.S...Portol erlrypexlt <br />671 <br />Transporters reguma(forexporti - -.7- Data leawng U.S.: <br />17. ThoughourvAlkiewtud?,wl of Raeglet of Weedcas <br />E <br />Tumaupa)Algdfreedl N <br />Mums, Day Year <br />ouvN7 Muv' &:1 <br />TransponolipVietaiaxil Nons, I send <br />Month Dar <br />VK <br />i1A. P � <br />10. Dlsuepanry <br />18a. DiecmVency lMlcallon Spew El comarav E]Tyo EIRgaidne 0 Panel R.I.B. <br />ElFuil R*d. <br />Manifest Reference Number. <br />IShAternasFiNdy dr(paWraor) U.S EPA 10 Number <br />is <br />Fardatfs Phone <br />1&. Signature orAtherate Facility (of Genre i <br />month Day 70 <br />19. Hazard" Waste Scrod Management Method Codes 11.0, codes for hazardous waste Vestment disposal, and recycling system) <br />- <br />2. T T <br />2S Desdqrmvgd Fachi Owner or Operator: Carlifieton of rucatit of hacandoun reakeriAls corona by ft mention 0050apt as ragod in lern led <br />lorr"ryped <br />771(v <br />sitheause <br />ZD ty., <br />of <br />Wd <br />1 <br />151,31 13 <br />EPA Few 8700-22 (My. 3-D5) Previous, adIfions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />