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Please print or type. Form des; ned fdr use cii Mlle(12-otch)typewriter.) Fon Approved,OMB Na.2050-0039 <br /> UNtFOR HAZARDOUS i,Gaf+ara4x tD Number 2 PctgaEmergency e9porise Phrne 4. nUosf Tracking Nymhar <br /> WASTE MANIFEST � � �ti . '00 <br /> 5,Ganorakr's Name and Whig Address Gr' rato(s We Address(if d1ferent Um mailing add—) <br /> Aft <br /> nw-ROD Mitt <br /> C RM <br /> Generator's Pow: <br /> 6.TrarvWter 1'Company Name U.S.EPA IR Number <br /> ;. <br /> 7.Transporter 2comn nyName U.S.EPA K)Number <br /> ai6Ir '( d. tj <br /> 18.t)e;grated Faddy Neige and Sits Addrei's U.S.EPA IU Number <br /> WW ftbfto LLQ .• <br /> iM <br /> Fac,�iity's Owen <br /> 9a, Vii,U.S:DOT€)oscop ion(w6j&V ProperShyipiiig Name,P4cwrd Class,10 Number, to.Cordsh srs. 11,Tots! 72 Urft 13.ftstd Codas <br /> HM aM Pada g Cd Y11 Na. Two Quantity WUVOI <br /> 1wwo saki(MI*W on ), <br /> g <br /> Ain- 212 <br /> 3: _.. <br /> 4 <br /> 14.Special Nand"Iretw..Uau and Additional InWmatian <br /> AWv-aF <br /> 15. -GENERATQR'StOFFEROR'S CERTIFiCATWN k fears fey declare Thai tlia ax is rA hie consign meet are fuYy oral aceurately doscr d ahovo by d e proper s4poing name,alai are i#aasi Mi padcagad, <br /> marked srA and ars in as respem in prdp®r cauition for varssfx i accetding to appkable intornsiksisl and Wonal governments reguhafiusis:U oxport shgmsent mid t am Ura Proluuy <br /> Fxporfsa,I caddy that the cordanla of lliis aDrudgiursent conform to the terns of the attached EPAAciuvwtedgment of, CIL <br /> I cagy that Ute walls minimization stalHrleiil iden68wt M 40 CFR 26227(s)(ft I ant a latgo quantity genoretor)or Of ams"quewy generator)is tnre. <br /> Gsnerawr` ro x M-th 'Dai' Year <br /> %fnfem si kiiport w U.S. ❑Fxperit from U.S; Port of wdryt e6t <br /> Transporter slgratsse(for eVorlsa,*):, Date leaving U.S.: __-------.___.- <br /> 17.Trag"derX tofRooaptofMatedats <br /> Trarspater t No tixnyped Na %rabxe (A xrtli DaY Year <br /> � � <br /> Trrsn 2 'iOTYPad maw DayYaor <br /> > <br /> 1B.D�rsepeaicy t�l ,.>�` <br /> lea.Dtstapaney Irkwj--pace L 1 Q.-* Typa EIRes" Cl Panel R*cUon El F.1 Rajacaat <br /> tRatif�IZFiferorico Number. <br />> 107ertwto Fealty(a Gmutatet) U,S:EPA ID Ndmbsr <br /> FatsPhrsno: <br /> 180Satuas o sacmah FariSty(or Gsnerokr} _ _ NlorNt Day Yeat <br /> 19,Hxrerdasus bYasta Ropmit}ianagament Method Csx9as(ikr (or haaarclous waste tiria4iknt,rg ;and racycdng spa'mt s) <br /> 20.Des led Faril y Chrw.ae orC"mlor.c4dificotion Vracewa haztpzima mutaials oovraai by yie manifest except r.s oiled in Item I& <br />} t dffypod N Silmhae Day Year <br /> rA) <br /> EPAForrB70tP22( PrevtoOssditapp ateotisdeW. ,. 1 DESIGNATED F GENERA R <br /> ,a <br /> E <br />