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08/02/2018 10:39 <br />Rz,2OLa-;y it.Y ROAD <br />3'.2•d r 361;8? <br />(FAX) P, 063/065 <br />`Pirr�::i� :17:5:2 -�d2: ;�,": • ��, <br />�i✓:3 �• _ 5.3].711 IA,; <br />ed57v4�"rJ't�C5r7��•. rre-„ ..•...,.r._.."�_........_ ...,,,.,•._.� . ,..•-,�...,..._.- ,,...�..�'i11....°,t�Ztd:.....,r..�__�..v�_,...t�.h�.`,..�,.,..::'t.:.�Ol.`13::i�,. <br />3.93 '1` <br />i 4'I -I f1 s,;^p R -U4 un rc,,vMud pnPar <br />ED - <br />AUG 0� 2018 <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />14 GENeRATOR'UFFEROR'S CERTIFICATION: I hereby dxkm mal the COMants at Ihle conallinmant are fully and aoraraiefy dwadbee above by 1116 proper shipping nems, and are daesffled, packaged, <br />marked ane Iabefedlplacerded, and ate In all reapecte In proper aorxStlan for irentpan acmrdtng to apptfaable Intematlonal and natlorW p6aemmen4al mgWatlons, <br />Qenerrua srblMrar s <br />Pr"061WW Na�6 <br />Nbnth Dty Year <br />� 16.Interr7a»Onal3Mpmarrta� <br />❑ IMp011 to vs, Q Expon from U.S. Pod of ernrylex+t <br />T-Opofw 3 etue for exports Only): Da1ei U.S,: <br />1$, TrvisponerAcknavfedgmant of Reoelpt of Meterble <br />Tremporter 1 Prl*d/Iyped Name SigrWlsre ` <br />7rarmpod� 2 PrNteer <br />17, Dfaorepancy <br />17a. Okcreperwy Indic <br />176, Akemele Facility I <br />Z FaCIINy a Phone: <br />y 17a Slgrwturs of AmWw <br />Q <br />t <br />r? <br />3 <br />ryped Nara <br />SPace COW" 0 TYPE ❑ Residue ❑ Poe Rek' o <br />18. Deafprw%d Facility Owner or Operator, CM lk&t on of rK*1 of melerlals Covered bY. the rnP Nfaet exeW as *d In I*0 176 <br />PilrllaWrypad Name ! &9�Ofk@ <br />18 -BLS -C 6 11879 (ftw, WN) <br />U.S. EPA <br />Manlh day Year <br />Morml Day Year <br />U Full RsjWlon <br />Year <br />Day � rJ Y.w <br />I_r I r <br />t �• i + � <br />TRANSPORTER #1 <br />