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ATTACHMENT 6 <br /> Please print or type.(Form designed for use on elite(12-pit pew.....I 1 f L Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS [1.,.Generator ID Number 2,.page 1 of 3.Emergency Response Phone an Tracking Number <br /> fins's <br /> WASTE MANIFEST AL,0091 <br /> 0 �502 1800�49- -3 71r. E8945 FLE <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> DTF'Stot*ton 14C.- <br /> 25'16 W,Wk,-.hwattpet FIN, W W'101!1l tfoq!---t-f-eef <br /> Stot4tum,t � itct ttt t,f A 0 <br /> Venerator's PhoneUMA"120-3 114- A T I t4 ty U-0 P 411 <br /> 6.Tra—nsporter I Company Name U.S.EPA ID Number <br /> C-It I M A 0 9 12. -�A 2 h 0 <br /> 'Pan liaftof5 Est"t f"11fientall St-1ViC*S'Ifto <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> t`: Ott14 adws-Son)ose 11 A 0 0 -:.i t-*4�f 4 1 1 0 <br /> 1021,Rmytssa Road <br /> (A'951,32 <br /> Faci,k'sJPhone:' L4 041 AA 1-6242 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> NOWIRMA IWARDOUS WMOU MA&I't.'01"'AMING <br /> 0 <br /> Owl) <br /> 0 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)ff I am a small quantity generator)is true. <br /> Generators/Offeroes Pflnted/Typed Name bignatura,- on Day Year <br /> —1 16.International Shipments <br /> il�- 1:1 Import to U.S. E]Export from U.S. 'Port of entry/exit: <br /> � Transporter signature for exports only): Date leaving U.S.: <br /> UW 17.Transporter Acknowledgment of Receipt of Materials <br /> E2 Transporter 1 Printedirryped Name Signature I on Day ear <br /> 0 <br /> Transporter 2 PdntOdPryped Name Signature Month Day Year <br /> ix <br /> 18.Discrepancy 4-' <br /> 18a.Discrepancy Indication Space 1-1 Quantity 0 Type ❑FIResidue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Gentretor) U.S.EPA ID Number <br /> Faci&'s Phone: <br /> LO18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> U <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> -T T- 4. <br /> LU 1 <br /> '0.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> .'rinted/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> uArL44-5 hwthe 4PAtopfiAte Pof"14tsfor and it ucepl the wa,'w the gpoef a3ali 1�sfiqqq�VA <br />