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Please print or type. Form Awowd.4MB%0.20M 038 <br /> UNIFORM HAZARDOUS t.Gonerator IR Number 2,Pie I of 3.Em Moncy Response Plume nifest Trasking Number <br /> WASTE MANIFEST t"AL.00035671,' 1 41-5-023.8771F L <br /> 5,GensreVsName and hla2ugAd ess J HS.41. tc(fitY'CLtt�t 'kill dilti3mhlRtiiF0f1 neraWsSdeAddmss{f0vent(banmai"aMiiss}~ <br /> .3200 a,FI t ore&St. <br /> Syn:;PlCrt,t;u .;. <br /> Gerutrators Pww a. 2€T�" d- <br /> 0.Transpma i Company Name U,S.EPA[a Number <br /> Anion Ricifir,l.inws�C�D <br /> 7,Transporter 2 Company Nam U S.EPA ID Number <br /> B.Ossgnatod Facd'xty Name and Sim Address U.S.EPA ID Numtxr <br /> F C)C, 'Itwi€ nrrt r1G71 <br /> Carbon,Git<lJ1 520 LJSA <br /> Fam ty`s PhCnts <br /> 93, r}b,U.S.OOT Oasaiption(rcxdi ,Pripet Strppsrg Nacos,Hazard Class,ID Nua&e, 1f}:Contafrmrs 11,Total 12,Una <br /> H6( aAdPackvx3G-p(dany)) No Type Ouanbiy VAN01, t3.YdaYatCodes <br /> tYt <br /> O r :�i.+ r�,s�r�r�.ra��: �FaaJ�reyrt�T,a,001)ir;avtX)CTr tdguli!Udr Ha C"' <br /> zLu <br /> 2. <br /> P. <br /> 4, <br /> 14.Speaaand AW1WW tnfonnatan <br /> R14V 'Pt r�1.,a «1t:E FY G1` PifttG i�t�Ca 4Ci 1 RAILCAR No. <br /> 15. GENERATOR'SdOFFEROR'S CERTIFICATION:I tweby dodare tt al d s cents o1 t)vs carlslgmxnt aro fair aril aoaraiefy descnoed abavo ay the propsr s!pprng naw.aril are doss fioq,packaged <br /> markod aril labe"VUarded,and ate in al mspecis M proper cvdtion for transport aoc x&V to app`!tablo intematlonalsrkl national govemnental regsgatans.It oxpcut d*r*al and I ren the Primary <br /> Exporter,I mthfy that dzo contorts of Uks cortssgnment wnform to rho tamis of ft allacdted EPAAdrgv„odgrrmM o1 Consant. <br /> I certify ftl""to m rrr 3zatian statement identfled in 40 CFR 262.27(x)(i(t am a taiga quanbly generator)or(b)(41 am a"quantity gonorxa)is two, <br /> Genera'r &vetoes Primed rped tram° Signatum f tdardh Day Yom <br /> ,J 16.InIomaw"!'tripnnts Ire to U.S. EI <br /> nv <br /> i— ® � L..,t Ex(xvt frau U.S. Port of anrylazrt <br /> Transannersgnaturo(fof exports only): Dale toavamg U,S.: <br /> w 17.Transpon"A0j*vA drwr4 of Rr t of A(a:etals <br /> uj <br /> Transporter 1 Pnanloypod Nam S groture tAm% Day year <br /> CL 1�I1(S�Ik� At �„01 <br /> z ransportor 2 PnmedlTyped rdame Signawre North pay yeal <br /> a— <br /> t6.Discrepancy <br /> 18a,Chscrepancy Wicawn Space ,1t t(�°-�t tf--�11 ReE� <br /> V__)Type L.a Resdua 11Paftia3 �d.=oft t..l_I Fu8 Rejecl;cur <br /> t,;2�sfest Relom+t=w Nlanlser. �' <br /> IRb.Alttrnwo FoaSty(or Generator} U$.EPA ID Ntmbu <br /> v <br /> US Farhws Phos: <br /> 18cti gnatum of Aliema°.o Faevdy(or Gerralor) th Day year <br /> Q <br /> a± <br /> 10.HaYmdous Waste Ropcat f)lw3gerttiznt fAermd Cases(i.e.,c0os for huxtiouswasto(Autin*m,disposal,and m ydng systems) <br /> t. 2. 3. 4. <br /> 2t),pea gnaicd Fati ty O tine r ar OPMtoa CerG'SCatnn o1 W.*of haWAIDus malcrals cow and try ft mani'ast except as ailed in Item 18a <br /> PnnitdTypodNoma ff SrgrtaWma Month Y <br /> i ! <br /> EPA'Form 8700.22(Rov,12(9u9 edibwls are obsolete. DESICa D FACILITY TO GENERATOR <br /> i <br />