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Please print or",(Form designed for use on elite(12-pitch)typewriter) Form Ap"ed OMB No.2050.0039 <br /> UNIFORM HAZARDOUS f Ganerasa lQ Nornbar2.Page t of 3.Emergerxy Response Plwna 4,ldanlf"t T s g Number <br /> WASTE MANIFEST ') e1 v 51 7 ^I 41? <br /> -4'3 #77% .:1:. t Ja t,s <br /> 5.9nera NaNamesandMaiingAddress NMWI Pa Address( dirwentthanWa ngOftess) <br /> ufs:-Wk G f'?f:-'�Ct.aCZG A9#?'VA1i;3M MM-IiaC>I`S` <br /> GeneraWs Pwo: ,e 2 <br /> ranspo tar ams U.S.EPA 0(dsmik3t <br /> J'nk',oR"r� <br /> 7,Transporter 2 Company Name U.5.EPAID Number °°`'" <br /> 8.Das gnaied Fao:,y Name and rtoAddress U,5.EPAID Number <br /> =8-s z ' 8 '•,St nrft€3`ls` <br /> Fabry s Pham... <br /> ga. Sir:US,DDT Dosaaipt;on lindudarg Proper Shipping Name.Hazard Class,ID Number, 10.Con 11,Tata! 12,Unit 13 Waste Codes <br /> Hi,j and Padcutg Group(il any)) No. Type Quantity wuvof. <br /> CEJf)sa)-ilji. ` X11 <br /> w 2. <br /> 9. <br /> a. <br /> 14.Spacial Har&rq Insnaws andAddtonar Information <br /> RO, <br /> 4";'A' l6 .g',f;t::; <br /> 15. GENERATOW&OFFEROR'SCERTIFICATIQN:I teratrj dedare M mcontents oft awsiprcntamtukyand acwiatety dftaW above by0snpcWstip*gctam.ax-dtaa ,parka , <br /> rrzftcl and Wberod'pr rtded,aM am in 0 rospeeb in proper 07witim for trenspod acou*g to awicabia y,ternarional and natlatat govommantal regulations,it export stWprnent srd I am tha Prntary <br /> Exiortu,I coroy that ft contents of M consigninent oonform to dre terms of Ore attadrod EPAAdcrwss4edgmeni of COrisent. <br /> l I certify Nat drn waste rninuruatiat statement identified In 40 CFR 262.27(x)(d I am$large quantity generator)er(b)(d f am a smati quantity generates)is free. <br /> nerar y .arWs rnaa ypedName y j 9na tae x a1 ear <br /> 16,interna xxrat 8h pmeMs �Import to U.S. El&,.d from U.S. Pod at entytazt: ss� <br /> ? Trarspxtter 'na!ureyo,$x ani : Date lea U.S.: <br /> 17,Tres SMW AGvmletk rent of Recut of M aWL-s <br /> s � Transports*! ruried7ypad , y ear <br /> r3. <br /> Z Tmnsporter2PrintedTypedNow goes a ear <br /> 1 <br /> 10,flsaepaney �r--77 <br /> 18a Discmpancy Ind=�t;an Spate Ouantily ❑Types ❑Rasttkw t_-1 P.&i Re;ecdan Fut R*ction <br /> Mantesi Refaw"Nustber. <br /> 18b.Akemate Faddy(or Ganera!a) U.S.EPA ID Nurnlrer <br /> a <br /> v <br /> �ad!r s Pira: <br /> W 18e QnatureofANamatb atary(01Ganeraiw) UnM Day Year <br /> Q <br /> Coq <br /> uy 18.Hazardcscra Ydaska Report Man,;genrent Aieltod Codas(i.a.,nodes fa hazaRious vrasta treater»!:d`rspbsal,and retyds'ng systems) <br /> Uj <br /> 20.Damnated Faci y Qxrrar or Opera!or Camr n r,f receipt of hazardous marerit%arrered by lire man fest ozxpt as noted In tWn 18ar <br /> PPO'edlTyped Namd 'gna Mc nth Day Yea <br /> EPA Form 6700.22(Rev.3.05) Previous editions are obsolete. OESiGNATED FACIC9TY t`^GENERATOR ST)TR(IF REQUIRED) <br />