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i -11 <br /> r� <br /> 5210 I296t?3� <br /> ri e.(orm designed torose on elite 12 flCh rifer. Form Quad,OMB No.20504039 <br /> J ARM NA211RDOUS 1,5 erwrelorl0 Number 2.1 1 of 3.Emergawy Resporaa Phos 4.ManNsat TrocUn Hum <br /> wasTe <br /> !A us <br /> o0 0 0 3 7 5 8 DAT <br /> 5.Generator s Nama arW Ma"Address Cer*f tors SAe Address(I different than maling address) <br /> Ht1�e Repot C/!) PSC AttR. Nt>ie Depot CSR NDtIE 1EPQT INI1�5 <br /> 5151 San Felipe REPOT 8((11415 251 COMM RYE <br /> 1 Genera - - <br /> 6.Transpufer1Company Nam U.S.EPA 10 Number <br /> 7.Transputer ompaoyName UVILPANIM953 <br /> 6.Dsstgnated FadityNeme ird SleAddress U.S.EPAID Number' <br /> GENERAL ENVIRU rOffAL IST, LLC DDB M ENVIRONMENTAL SERVICES <br /> 11855 VH17E RUCK ROAD <br /> Feck'Ps lohocro:MM ISM (9111 3SIjga* <br /> pa. 9tt U.S.DOT Desafption(indud ng Pmpar Shipping Name,Hazard Clase,P Number, 10.Ocrkeirlers ii.Total 12.UnN 13.Waste Codes <br /> HM ardPackin9C*"(d&M) No. Typo Quan9ty WLNot, <br /> rr 1' NON-RCRA HA7RRDM HASTE LIQUID (PATER .JW PRODUCTS) DF 16'Z P 152 <br /> s 2. <br /> NOR VASTE AEROSOLS, RAMILE, A.U.S. (CNRO in, MET83L E wL 1811 11105 1187 <br /> X KETONE) 2.1 ttIRR CONTAINERS (NIST CUIfNLr UI3N 183 S#' 1(296) <br /> 1135 1" <br /> 3' UK993 PASTE FLWdW LJOWS, N.Q.S. (WINE, ""HE ETNTt. 1D11 1836 <br /> KETONE) 3 PGII (FI.RWID10:26.86 1 840111) l .Z— P <br /> 4. $ <br /> f �f <br /> aaAing tnstvdans and cdOmidm / !X u5 l x'3 6 <br /> (1) -15 - qjN-RCM Me WIE6 (Z) -.1-105 - E96(126) OSOLS FIB (3) HOWAS - E'RVIII) RAMILE <br /> LOOS ( . <br /> -a) r X�r-r- <br /> 13. GENERATOR'31OFFEROR'3CERTMATION:I hereby dacbee trot the contents of 81Is consignment arm tW(y and awuratoly dwAW above by the proper shippkg name,ani as cleastfed,packaged, <br /> marked and lababditollecarzied,and are in all respects In propel caldillon for hnsport according to applicable IotemMlorm)and national governmental regulebxu.tf eW sh¢xrrent and I am the Primary <br /> e*odu.I cerety that the contents of this eonabnmeni aosform to to recces of to attached EPAAdrnoMedgmeni of Consent. <br /> I oe*that the waste minirTkakn statement Identified fn 4O CFR 282.27(®)(d)am a large quendy generator)or(b)(HI sm a WA gmItb goner�r)is hos. <br /> Germtoe roc s t'rintedirTyped Name 8 e m ortm Day YOU <br /> !( <br /> 16,triternelionel Shipments <br /> ❑Impar to U.S. FXportfrom U,S, Pod derirytwdk <br /> z Mansporrersignatwe for exports only): Data leaving U.S.: <br /> W 17.TrartWorharAcknoWedgraeotd Rem#of Materials <br /> Transporter t PM%WypeOName / Signature Mortm Day Year <br /> a /Jr1 <br /> Transpater2�+ntedtlyped 3gnaknm month Dw Peer <br /> 18.Disa'epalcy <br /> lea.DbawncylrrdcationSpam ❑QuantAy ❑Type ❑Residue ❑Part atRejecticn ❑RA Reject. <br /> Manliest Rafemnce Nu <br /> 18b.Aftemate Facliq(or Generator) U.S.EPA A Number <br /> J_ <br /> V <br /> u"E- Fadlys Phu1a <br /> ,Q, 18c Sigr,atura of Attemaie Facilty(a Genaretor Month Day ear <br /> 19.tbzandous Waste Paport Mm"meni Method Codos(.e.,codes kr hnzardoue wo4ohatmAdkpM,andmcydingsydaR4 <br /> +� t. <br /> 12. 3. <br /> 20.DesignaW FacPky Owner or Operew..Cartificadar receipt d haraNaae mak rials owered try the menrsat except as noted In Item 168 <br /> a ay--"Wu— <br /> 'A <br /> ar <br /> a 11 <br /> EPA Foo 8700•22(Rev.3.05) Pr edftlonsareobs OO, 1 IESIQrNA D FACILiTYTO DESTINATION STATE(1FREGORED) <br />