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08/02/2018 10:36 (FAX) P. 047/065 <br />z <br />N•HAiUI)O 19 1 • (;anareoer l0 f4umtier 2. Page 1 of 3. n <br />oY l Phones 4 weste <br />WASTE MANWEST y��t 'i r'.'=li �_:i�f i'f? ty / 7017 ✓!G•( �, 7,'i � TraddrlgNumbar <br />F.�Q4flOritor Name end ►aryfn Arm'+ j f Ga:eraws Site Address {p cooMN MM mal ? <br />�1, odt/ :��'� r G, T�WC', ( (77:'1;D, o;/ � e. 1 <br />r b e -,I + c.. r <br />t3. TnnepoAer i Company Name U. EL EPAyyID Number / <br />�' ✓✓? `� 'i�U C.:l i'3'.J r i�ii'o 0...:A: i�r.i �I <br />7. e- <br />Twepoftr 2 CoMpa <br />Name U.S. EPA ID Number <br />OT <br />B. De{� aled^^F��'Sly�N�ww°me and glee Apt�ld/t�ase t 1t u.9. EPA ID Numb@r <br />LL�� r. <br />' �:.«U 37`S 9'�+^^ :77�� +iirfl i"ann pp,(ii'' '"• ��('L'. �y \� !'��3 �Y ir�r'��eVia`• - <br />FaaiN 'aPt>one: C-07) <br />9, waste Shlppinp Name and llee#*M ti ( } 10. Mamas 11, Toth 12, Urut <br />1 S " No. Type Quandly WLNol. <br />'j+, bljoo d ��C, <br />z. <br />a <br />3. r <br />4. <br />13. Special Handit IflAMlere and AddPirW Informal on <br />1!-fAL <br />Ei�tVIR'.!.rp\AEN . r�ENT <br />H�p,Lrt t U <br />14.OENERATOR'SA)FFEROR'S CPRTIFICATMN, I hemby dedam that the oWents of the oonelpnnwl are holy and owuratoly described aho o by the proper ehipplrg name, and are daaslfled, packaged, <br />nudrod and lobolo#laoanied, and are In all respacla In proper Condition for wwW rt Awarding W applicable lnlemalk d and nstlonal goverreruntef regulations. <br />Qanerator JdOderor a PrinlednT * Name Slpnadlra Ala* Day Year <br />t 3 r7 r <br />16. Inlamatlonal 9t>Ipmanta <br />let <br />❑ Import b U.S. ❑ up" Us. Pon of enlrAlt <br />Tfamportor Sl attire(for Delo Ieavin U.S.: <br />la Traupoder Adwwhpdgmenl of "fol Materiels <br />Tmaepd�ter 1 Pdn N°nte Signature 3T <br />¢} fdi� I�•,.�n_,^aYor�_ �. i�s.�.•s_.rin-,n r "lmi V'i� r Yti' <br />"l <br />vr. <br />17. Dtatmpwxy <br />178. Dracrepancy IndloaWn Space Cj <br />Ouanuly <br />t7b. Memale Fadlfly (or Generator) <br />7c. <br />(or (ienaralor) <br />qk <br />LJ Type ❑ Rome ❑ PWW ROOM ❑ Ful Aajedlon <br />Number <br />Morn) Day <br />i. Daelgnelad 4 Owner or Opoor, Certlflaetbn of recefpl of materWo covered by the maniteel o4opt w noted in Item 17a <br />Norn 1 � ° tTS sl <br />gut" , .r' , Day Year <br />/,- <br />" r <br />LS -C'5 11979 Mev9/09) f"� ! Ttynnrenn��., as <br />