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<br /> C Please`o nt qr. ..Form de tied for tion elite 32- itch ty ewriter. Form A ed;:QMB No;206P-0038;
<br /> 1.t3enerator ID Number 2,Page 1 of 3.Emergency Resporuaa Phone
<br /> an t rac ing Number
<br /> UNIFORM HAZARDOUS.1 , ., . .. .E --
<br /> WASTE MANIFEST C,1 t 8'1 - (877'} 577--2669 - ® 9 4 2 8 c -
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<br /> 6.Geoaralor's Name and it ngAddress _,_ ,. ._,.___...__-Gonamtot's'8liwA06,rass.(iFdSBarenFtitan maf �ddfass
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<br /> -8.Designated FpdUly;N an ;SIle. ress . U.8.EPA ID Number
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<br /> 16. GEN ERATOR'SIOFFEROR!S'CERTIFICATION.I hereby.declare:ihafthwoontents.of llls con4nmentare fuly and acmiraiefy,desq.". sWvo'byrtlls.;pt0,ersh0pfAg rrdme�and$►e dr ssfffed,.uaakaged,
<br /> markedendlabblo fptacarded,and'arainellrespectsInproperoondi#DnfortransportaccardtngtaappkcablelPtamatlo ,ww.r4on gav�nmentaLregulallons Ifexportsitlpmerdatrd.tam:B:ePdmary
<br /> Exporter,.roerilfy;0iat.ttre•corrtents6fthio consignmentcoritantlo:the:tarmsof_the:affac d.EPA'AtknovAgdgmentafConsgliL"
<br /> t1;er8(y'tt�ttlioWas�minimlzagon'stalernantldamtifliitlih 40•EFR.28227(fa)`(Itl�am a Iargs�c�enWygeirarat�}br(b};(tfl`arn•'aiardall•'girenllygsrwralor):Istrue,
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<br /> Transporter'fPrYrtsVWed.Name Muer ,. ay YOf i
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<br /> 18.Hwmdous•tNasteReportMa!mg ntMethod:Codes(ise.,codes�torhazarctauswaMWabmtk.tlispa�,and!re .ggrsystems
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<br /> 20.Destgnat6dFsclrly.OwnerorOperator 0erll6callorrofrecelpI.cPhazardoes:maleriplaocveredhygie,martyeslexcetrl�strbtedkrtfaml6e _..,__....._....
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<br /> EPA Form 7 .22.( ev.3=06) PrevIous areobsorete. DESIGNATED-FACILITY-T-0 DESTINATION-STATE:.(lf REQUIRED.),
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