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Form Approved.OMB No.2050.0039 <br /> Please print or type.(Form designed for use on elite(12-pitch)tybewritar) <br /> 1,Generator ID Mumbai 2,Page 1 of 3.Emergency Response Phone 4.AlanifiestTracking Number 1 1�. E <br /> UNIFORM HAZARDOUS a tl Ck;� ► f ( 0f`))4 >" "�J�f� <br /> WASTE MANIFEST r0 A 1- <br /> 5.Gen¢eraiots Mam/fe and MAIN <br /> Address Generator's Site Address Qf digerenl than mailing address)° <br /> ER <br /> i(PEr; 1€std . I`4 �' �t 016 10H <br /> :tet Y) :`€( tre i7, <br /> Generator's Phone U,S,EPA ID Number t <br /> 8;7ranspodef 1ompahy Name <br /> tr b.f ,( tj� f►� � {31r `� _;t��t` C. <br /> 7 r ? s I <br /> U,S.EPAID'Number. <br /> - 7:Transporter 2 Campany.Name•:'-. " <br /> 8.Designated Facility Name and Site Address U.S.EPA 11)Number <br /> NISI URs"E N V 1 RO�NNfiFMTA A <br /> Facilltlfs Pbone: E2-09)64 - A 2 5 <br /> fib.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> Ra, ii.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wtivol' <br /> 1'fNON41"O i^it`'fr�wo3fdsvmm{lQuib(t ul y lmA mq) -"''a <br /> r <br /> 2, <br /> 3. has the appropriate permits to T <br /> receive your waste,and has received your waste T <br /> Our EPA 10 Number is CAL 000 383 6S0 <br /> 4: <br /> 14.Special Handling Inst(uctlons andAddlkional Information <br /> EMERGENCY 6�3i'�i FuT;E;i-f��ATRE:C 1,M)-424-9304 i�'1OE`1'MOMMAL:FkRt�:� Ft RSO��I. <br /> F C lbi �f E `{' i~'6�? i 1'NC Y OHM— $;SHE it i G SAO-424-9300 :z 'ti ilCi� <br /> 15, GENERATOWStOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and iabeledfp€acarded,and are in all respects In proper candition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of Ibis consignment conform to the terms of the attached EPAAcknowledgmant of Congeal. <br /> I carlify that the waste min-smization statement Idengilin 40 CPR 282.27{a)(if I am a large quantity generator}of(b)(111 am a small quantity generator)is true. <br /> Generalo>'sfOtferor's Printedr7yped Name Signature ." Mortih Day Year Ili <br /> - 16,International Shipments ❑Impod iii ❑Expert fnf U.S. Port of entrylexit: <br /> --I Transporter signature(far exports only): Date leaving U.S.: <br /> LW 17,Transporter AcknowledgmenlofReceipt ofMaterials rt <br /> vr—a—nspodor <br /> spa r f Prints ffyped OagnMonth Pay ear <br /> Y 2 PdntedfTyped Nameignalu MonBr Day Year <br /> PC <br /> F-- <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space F1Quantity F-1Type ❑Residue ❑Partial Rejection L1 Full Rejection <br /> Manifest Reference Number: <br /> ifib.Alternate FaciI4(or Generator) U.S.EPAID Number <br /> v <br /> LL Facillys.Phone: Msnkh Day Year <br /> UQ 18c.Signature ofAllemute Facility(or Genaralor) <br /> a <br /> iR.Hazardous Waste Report Management Method Codas(i.e.,codes for hazardous waste treatment,disposal,end recycling systems) " <br /> a <br /> 1 2 3. 4, <br /> 28.Desi natedraclwner or Operator.Codification of receipt of hazardous materiels covered by the manifest except as noted In Item 18a <br /> g Month Day Year <br /> PrinledCfyped Name tgnalurs r <br /> EPA Form 8700-22(Rev.3.05) Previous edillons are obsolete. DESIGNATED EACILITYTO GENERATOR <br />