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Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No 2050-0039 <br /> UR=4.6Ru•y`AZARD0US 1 Ge"era''r ID Number _ j 2.Page 1 of 3.Emergency R sponse Phare 4,Manifest Tracking Number <br /> WASTE MANIFEST I. D �7 j f SCS 4 00 <br /> 7436342 FLE <br /> Z).G' eta i' Name a xl , prig S Gererato(s Size Address(if dfierect than mailing add ass) <br /> Gtnzrato!s Phone I tY`43 P6 4 <br /> 6.Transporter t y game ,,{ / U S EP umber <br /> i4 CtV*lCA� C`..��er�tC'�1 -Tfr,12 ��'' Cha I c0c,0705-4 D <br /> 7,Transporter 2 Company tram U S.EPA umber <br /> 8 zsignate1 Fac'y frame and Sete Addi ss U S.EPA ID Number <br /> Faci 's Phone q2i- 31-f1f <br /> 9a 9b U S DOT Descnpton(atduding Proper Shipping Name.Hazard Class.ID Nomber, 10 Containers ;t ictal 2.Unit <br /> Hki and Packing Group(d any)) 13.Waste Codes <br /> No. Type O;anr-ry "'W"Vol <br /> ZC41010"o !tot (.1 <br /> ►�1 <br /> w <br /> Uj 2. <br /> W <br /> 3. <br /> I <br /> 4. <br /> 3 <br /> i <br /> 4.Special Hardkng Instrucnons and Addihonat information <br /> 1S. GENERATOR'SIOFFEROR'S CERTIFICATION: I he eby dedare twat tie contents a this censgpnicnt are fully an accura(e`y described above by the proper shipping name.and are aass:Red,packaged. <br /> marked and IabelcS'p!aurded.and are in a'I respects in proper cord lion•,for transport according to appticable international and nalwal governmental regulations If export shipment and I am the Primary <br /> Exporter.I certify that the contents of Ih3 consignment conform to the terms of the attached EPAAcknoMedgment of Consent, <br /> I certify that the waste"rilmzation statement identified in 40 GFR 262.27.0)lit I am a large quantity generator!or(b)(if I am a snail quantity generator)is we. <br /> f <br /> ofaWs/Offerofs Printed;ypedQ amegnaraeCfj t. ay tt e <br /> 16 I::,ern -ional Sh,rme. I�t <br /> z11Importto U.S. 1J Export from U.S. Port of enWexd: <br /> Transporters Batu-e for exports on; Date leaving U.S.. - — <br /> IX 17 TranspoderAcknowtedgrnenl o`Re". 0 k4 -dais AV C4; <br /> �j <br /> CL Tr c'r P.j,7lf.� r�'dName <br /> ry 'moi <br /> O <br /> CL 11VVVVV//I/I 7K~) , I <br /> � '-' C L <br /> Q Tr nsowter 2 PnntedTyped framef.an[n Day Year <br /> 18 D scr" <br /> 183.D s pansy indcatwn Space El Quartlily ❑7ypa ❑Residue ❑Parroai Rejection e� ❑Fufi Re)eetion <br /> Manifest Reference Number: <br /> 18b.Attemate Facility(or Generator) U.S EPA ID Number <br /> J <br /> V <br /> Q <br /> w Facifav's Phone <br /> C3 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19Hazardous WW Rewrt Manaderrent Method Codes(.e.o3des for hazwdous waste treatment,d s I,and rec ySterns) <br /> � posa yc;"9•Sr. <br /> LU < -VA���/, 2 -- I3. a <br /> 20.Designated Fad:1.y-O%ner or Opo >.or Certitca;ion of rece,pt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrntedTyped Name Sgnatum t::;nth D`P,r Year <br /> EPA Form 87W?22(Rev.3-05) Previous edit-ons are obsolete. DESIGNATED FACILITY TO DESTINATirJN,;TAT€'(H RFc:)t;'r t=:")j <br /> .rr <br />