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Please 1�& or type. (Form designed for use on elite t2 ' <br />Form Aowovad. OMB No. 2050-0039 <br />CF-Arwmcluu-"tner.--w) rfwa= eanons am cosmos. GENERA OR'`s' f:`G! i t;:.. -- <br />U RM OUS 1.t ai <br />2. 1 of <br />I3.&MgwqRw here <br />tanbar <br />9771 JJK <br />WASTE MANIFEST <br />W2 <br />, <br />�. .• <br />cwwatoe? Phone. <br />6. TMSMW t U.S. EPAID <br />f " <br />:t 4 `.m%it\-'i r :tsr,c.-,,.4� 'Al r)(. q<!e f i <br />7. Transporter 2 Company Name U.S. EPA 10 Number <br />11. Fadeity Lone` and SAe L u f :.c :' , �.-�; � ' � j U.S. EPA IO Number <br />r►r,-;.r. <br />Fa h ys Phone: <br />ga. <br />IIb. U.S. DDT Proper ID MxNw. <br />10• <br />11. Tia! <br />12. Unit <br />13. Waste Codes <br />Hu <br />and Gw td ems)No <br />WUw. <br />777, {--f -:7Z e, rf rPt "F , t /�-'. j� + 4,r '�< <br />/ <br />r <br />3. <br />4. <br />s <br />s <br />14, SP struCtions and kJormation <br />�''f ! f.i C 4. R.°C'.. .a&. •1r+4 �d I Ems f r t R f !S ty t•% ��" a �d, t r �•f�'f°sF ' d�"M''i t'7d [rf %t e� t f P Ir 'l. T•' i .• .h ' J� <br />15. MERATWWOFMWS CER'tIMTION: I hereby declare thud to contents of ft cxwVd=A are hal' anal by thre rren e. ab am <br />mm*W and labsiedAplaciuM, and are In d nispects In to APPIMble InturdWial and national gmwnmental mgulations, If export shipment and I am the Pnmary <br />I the contents of this =Wrdmd wnbm tithe W= of to attached EFAAcImowWgmwd of Consent, <br />I axtthy than tare statement In 40 CFR 2MV(a) Of I am a Wp quantdy or (b) ('dl am a wa quantity tor) is tare. <br />GaneC tOPA Month Day Year <br />J <br />t- <br />Is <br />❑ Impod to U.S. ❑ Ezport tom U.S. Pat of O*y/e* <br />= <br />Transpo w (for evom ont# Data Isaft U.S.: <br />cc <br />17. ThiraponerAduvAeOgmentof ReceO of Materisis <br />Trwspoftr1 PrInfedrryped Nam Signature Mach Day Year <br />Thmspoft 2 ftteffyped @ <br />Month Day Year <br />le ' <br />itta Ownpancy wcation, Space ElQuAn6� ❑ TM ❑ ❑ Pattlai ❑ FuY R emon <br />Manifest ReWenoe Number: <br />I W Akemate F (" ) U.S. EPA tD Number <br />u <br />FacWs <br />ik 94it ue (of Month Day Year <br />4 <br />h1$. <br />Codes (i.e, codes for huentus no beetwK depoew, And mq&V syglame) <br />Uj <br />1• <br />2 <br />4. <br />44- <br />13. <br />20. ' FacRy Oww or Opsnalor Cwtification of tecelpt of hazanious maWals covered by the manifed exoW as noted in Rwn tea <br />PmftafTyped Day Year <br />• s <br />CF-Arwmcluu-"tner.--w) rfwa= eanons am cosmos. GENERA OR'`s' f:`G! i t;:.. -- <br />