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'lease pr;�ar . =deslgned itr use on este(12•plt 'ter.) Form Approved.OMB No.205000: <br /> UNIFORM KUARDOU$ 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tradting Number <br /> WASTE MANIFEST CAI.000=w0 FLE <br /> 5.G s oma atn0 +ng Address ratans Ste Address(it d4terem than mau"address) <br /> 3s. <br /> 11ff10�f <br /> Rfp01� <br /> Slutio0,CAM <br /> Goneratoes Phone: 2034-7700 <br /> 6. ra ¢r I Company Name U.S.EPA ID Number <br /> 812SkyEWAMINIkel lal saidbinis M000346016 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> EQ btduslrlal Sr mks IMK 433 642 742 <br /> 8. e� iy Name arta ss U.S.EPA ID Number <br /> ffthw <br /> Facility's Phone. 776453-2203 NIM30010000- �. <br /> 9a. 9b U.S.DOT Description(inducing Proper Shipphq Name,Hazard Class,ID Number, 10.Conta!ners 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(d any)) No. Type OuanW WtNol. <br /> 0: 1• 352 <br /> NwRCMHuardars V*de.Solid (Debris) Qct I M 2 SO <br /> LU <br /> 2. <br /> W <br /> 3. <br /> 4. <br /> p M Instructions and/WkWbDallnfam Tri <br /> SMOENCYCONTACTCJEFF 1RHODES <br /> 15. OENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consigmmant are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledoacarded,and are in all respects In proper condition for transport according to applicable intemational and national governmental regulations.If expert shipment and I am Ne Primary <br /> Exporter,I certify that Ole contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statunent ident lied In 40 CFR 2M27(a)(8l am a large guanity generator)or(b) dl am a small quantity geWator))s true. <br /> yped / rgnare Month Day Year <br /> 2- 10 1/. <br /> rj 16.In tional Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter sifirunure for Date lea' U.S.: <br /> W 17.TirensportorAd ro Medgnkerkl of Receipt of Materials <br /> Name gna reworith Day acct <br /> 0 <br /> CL <br /> Transpertar 2 t !Typed N;me Signature o ay Year <br /> D 2 1 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Re;�ectlen ❑Full Rejection <br /> Manifest Reference Number: <br /> tab.Alternate Fadidy(or(ionerater) U.S.EPA ID Number <br /> J <br /> V ' <br /> Facila s Phone: <br /> IBe.Signature of Attemate Facility(orGenerator) Month Day Year <br /> X <br /> y19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treaIrmnt,disposal,and recyaing systems) <br /> O 1. 2. 3. 4. <br /> got <br /> 20.Designated Facility Orrner or Operator.Certification of receipt of hazardous materials covered by Lire mardlest except as noted In Item 189 <br /> 7"— <br /> Name Signature Month Day Ye <br /> G � - 5 <br /> :PA Form 8700.22(Rev.346) Pre ous ediUoms afe obsolete. DESIGNATFn FAm ITY Tn r:FNFRATr <br />