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08/02/2018 10:36 <br />(FAX) P, 045/065 <br />CIV <br />NON-HAZARDeneratoriD Number <br />WASTE MIANIFEST11 + •�y} �`+-� .,{{,1� <br />7 P1111gli'777,111 3, E"'arDY Raapalee Phone 4, yVaate Tracking Number <br />F' '7 <br />- 191"') ..rj.rr —.1 <br />Generals Name end Mal ingl!A <br />f'^. <br />r 767 � � r✓' � d <br />U �= •�' (r C,- 3 �� G Lid 0. 4 l.0 tA•� . C� l� t, Oerlerafafa site Address (t dlrrer>9nt jhan meting I <br />3 <br />I ala Ufa �•!�'�r� fC -. m I <br />"i C ! %� �•f <br />Lc, r �PJ.filr�tA <br />.�.� <br />r—A <br />Genata s Pfwn0: '7 rj -71" <br />8. Transporter 1'Company Name <br />1/11/1 . 3 • 0 ""N <br />u.S, EPA 10 Number <br />7. Tranapada 2 Cornlyny Name <br />I <br />un. EPA ID Narnbar <br />8. Det! t <br />� ed Name end Ske Address <br />:':O ] 1 L"P1.112. .1 r"1 C <br />U.S. EPA to IvLwrw r <br />Z,"3 <br />Fadf 't Phone: -'-7'ety <br />9, Waste Shipping Name and Description <br />10. Conwnem 11. Tolm 12, Unlf <br />1. <br />No. Type Ouanuty Wiwi. <br />1- o u �C' --r 4 eye <br />���� 00 ; <br />2. <br />3. <br />i <br />1� <br />4, <br />13. Spacief Handling inatructbns and Addtllena! Infomrakon <br />ItI <br />1 <br />14. GENERATOR'SpFFeROR'S CERTIFICATION: I hereby dadare that the ccrrlents of INS oonelgnmtnt are fu* and accurately desaibed above by lha <br />medced and Ia6eMdtplecarded, and are In ak rasimit In oondklod for Ireneppn etapplrtg Hams, and are dataified; <br />proper <br />OareratoreADffero�a Frhloril yped Name <br />according to eppMceble Inremetlonal and nationalrxop•r Ptdraged, <br />Dovemrtlenw repuiepone, I <br />$ Mont pay Year <br />(s. rnitrrlationel Shipments �--I1E <br />0 Import to U.S. <br />• , f , <br />Export from U.S. <br />T rter r al- oft on : <br />Pon d e w1: I <br />18. Trenepprter Acknowfadgmera of Fiacelpt d AABierlsta <br />Dat@ Itav U,3.: <br />Trenaponer 1 Prtrted?fypad Name <br />r <br />�77�' Year <br />�f: <br />poner 2 PdnlerHfyped Name <br />� 6 r-✓L-�. a f C <br />Stgr,atura M" Dry Ya f <br />7. Qta�pency <br />7a. Dfacrapancy Indioerion 3paoe <br />Quarrtfly tJ Type <br />❑ Retlduef <br />❑ Par1Ia111eieckon U Fuu Rtlecllort f <br />I <br />'b. Akemals FadAly (ar tlanera0r� <br />Menllgl fielerenoe Number; j <br />U.S. FPA ID Number 11 <br />01ty's Phone <br />Signature of Ak;rm Facik (or Generator <br />MonNr Day Year <br />a <br />I <br />r. <br />Detlgnalad Faokfty Owntr or operator, Cerllfiaerkm of receipt of male,iale covered by tht menkeq except as nosed fn lltm <br />rvdrl'�ad Name <br />r''^�il=,,y �:rl -,'1�'?.���:-- <br />, <br />,�e�r:.`�'" 4 J..__.:�..,,.«.,. ..�„ ►torah b �� <br />- - •, � <br />6•C 6 17 979 (R�v, 9/09) <br />",,,,, . r <br />TQ®lgQbnmrt--m ua f <br />