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x, �t <br /> Please print or r Fdrm` gned'for use'on 016(12p1(6)tyPewnfec) " Form APProved.OMB No 2D50 0039 <br /> UNIFORM HlzARDOUS. 1:;Gen9retoilD: bar 2 P' iof 3. R snFhonO' 4 ManlfestTradd Number. <br /> WA8IE:kANIF.EST C�4l i t03s 5T t7 4'fry'� �: L <br /> 5. to a ttame arld Maiing Ad ilk ra3 qfMerant Wn malkng eddres5} <br /> :?AL 9VC,RELY firm,WMm WnfH?nca, <br /> C-OWStar'e Ptwne:.: <br /> ra y U.S.EPA ID Number <br /> •7ro L�nres.CO , . '`�' fl1:�921310 . <br /> T.Transporter Rgi;. any Name': '. U.S;EPA ID hpmbor , <' <br /> Deslgnatad Facdtty Name and Site Addrasfit : U.S.EPA ID Number. <br /> EC€5C grNkonmenfad 11TC003012Z1]1" <br /> 11.41 Wept HWw4W 123. <br /> UT 8454 U% <br /> €adgy+is Prone, . . <br /> ga gb U.S:DOT Dascdp8al.(hchW ng Proper ShtppNtg Name;HazaM Class,ID Number 10.CaitaYt§rs. 11,Total 12:Unft- <br /> HM: and P ( enY}) No:` Typo Quantity WtJVof.. 13 Waste <br /> o .. ice' ,R O Z arc.Sim(ivv"it�s�3� <br /> c7 , <br /> 4. - <br /> - t <br /> 14.SpechtNa ldl9tg inatnftlbn9 and Add1bonai Information'. <br /> sew <br /> 15 GENFfRA R SlOFFERDRIScEOFICATION:I hereby declare that the cohtants of this•caislgnms t are fogy and ampratety dgsaibed abdva by the priper�ipping name;and$ra classRied,.paacaged <br /> rijm4ceq and is; d<pl'acatifad,ehd aro h p11 reapecb at proper Ganditlon torh�aneport ecoprAhtg W applii�bla Inierna8orra0 and na8onei govgmmental regJlatbrrs.It e>zporTetiEpmant drid f am'ihe Pmnary <br /> t; Expator;f ir8fyfhat the ca lenlg9Lltits cpmslgnment ogtdormlo u,a�rmsnf.iha attached EPA7tc�mov3gment MConsenl,' <br /> i <br /> ICA that the*este mtnd r stetamont Janet din 4D CFR zsz 27(p}(ff t arn,a terga gi,anlity garreratai)or{b)pi l ym a quanGty�«wralor)is true. <br /> raon n na rg ay ser <br /> -;+-e {L { <br /> 4 18.1ntetriationat Sri hts j <br /> Import to U.S. Export from-U.S., P.ori:of attbY <br /> T tun for rte ord :". Date 19a nn s <br /> x..17.Tr4itepbrterAckiwx�mdgmerit o1 Recetpt of Materials � .: _, ,' _ �{ �i•,rr•:i'..,: ' <br /> Tratspo 1 <br /> z T lecViypadNune tura ay ear <br /> 18.f)ESCleperley...;. •" .. <br /> 18a. lied MIIt l Space <br /> ❑Qaranttty ❑Type �R"clue' Q Paihal ReJxt on. ❑FUII Rejecdwt '<, r' <br /> .. <br /> Manifest Were nce Number," <br /> 18b.Alte wla Fadgty(or.Generatdr} U.S.EPA Ib Numdor <br /> 'Fadi s Pho la:• - i ro r <br /> �: i8C SignaWra otAitnaia Faclily(a Gerieret«} : ; Month Day <br /> 19;Ffazarda INatta RoportAtahagemar tNpttod Codes Qs�cgdesdoi.hazamlous waste t*lrnant,disposal,and ta*y rtg systema) . <br /> 4 <br /> 20:beg'"mac�ty th9viat or D calor Certtgcat(on tf ra ipt of 1}4 ariWs materals cavetad by pio mar t(esl exie t as notcdIn Il6 <br /> ri'18a <br /> Ptin• area Egnature. Month . Maar; <br /> C . . <br /> EPA Formt3Fix122(f?ev.:3 05).Prssnous editions are otiaotsta DeSIGNATEp FA .r TY TO`G NERAfOR:i FATE(1�;f�E4UIRED) <br /> .. .... .� , tl . '.. +zF{1'::`•<!�',.. ,i;..� ,.s.s i.r. ?.�a£r.5t. .i1�!,l;r..' ..+. +.9, t., s, , c ,...,,.<r r. .., y w e, ,.. a5' ...5}a( <br />