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I[w <br /> 3✓ ' <br /> Please pri0t or type.(Form designed for use an ellte,(12-pitch)typewrifei. FormApproved.QAC Nb: <br /> UNIFORM I{AZARDOUS i.Generator Ip mober 2.Page VofLEmergenq Response Phone. 4.ManifesCTra Nmnber <br /> WASTE MANIFEST uAtu'DtA �` 1 23".94d-V14 2 J. <br /> 5.G;aimlloes►//Name <br /> {and M MafingAddmss Generators Slite'Adddr{eys�—rif iptere6n�t than me8ing addiess), <br /> EEIXQRr`Q• <br /> sfC3Cii'6ON.-CA <br /> 9MCKTON,C!! <br /> Geneiatofs PUane: 4d• <br /> U.S. <br /> 6.Transpatter1_CoRyierryNeine: EP <br /> AIDNUmber <br /> t(ir'9t}7�@'dttE.�;,QyQ�c67C: _ <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Deslignated tact ty Name and Sffe AddessrU.S..£PAID Number <br /> .}mg KUNDA ..jam. <br /> Fafti Phone:'. <br /> ga 96.U.S t]O7 Description(Nhichrd ng Proper Shipping Names Hazard Class,ID Number 10.Crpdainers 11:Tota!. 12.Um't 13.Waste Codes <br /> NM .and Packttg Group•(d arry}) No. type Quantity <br /> x 1. MOM RCi�a r� A��•�I f�tlt'Fr��:� ��t fly(�� F��A8EEu7g �g � �,A �, <br /> n <br /> 3. F1 B.r- F <br /> o <br /> , <br /> r <br /> 4• EDA T <br /> 14.Special Handling Instructions andAdddiorrel infotma8on. n_•, <br /> fa''FFt:"i C'IV l <br /> 2-373 <br /> 15,:iGENERATOR=FFERDR S CEIU*ICA=N:I hereby declare that the contents of lid's oandgrment are a intend jor land jilloni i g above nteI a txaper PPth9 acme,and are classified,packaged, <br /> madkad end labetedtpiaWded,and are in a8 respects in proper oonrSion for transport acceding to appticebie tntemational and natorcal govedmnerdel regufadons.ff export stdprr�nt and i em the Rdmmy <br /> Exporter,I ra*that the contents of flits consignmentcadain to the Was of the atiadied EPAAclmowiedI meat of Consent <br /> I'cW ft that the waste mialmvetlon sthtementMentified th 40 CFR 26227(a)(if I am a targe quantity generator)ar(b)W am a"!quantity genwilad Is We. <br /> S MonthDay Year <br /> Gene <br /> �• 16.Intemallonei ShipmentsImport to U.S: ❑Export frau U.S. PodofenbWexit <br /> Transporter signature(tor ex •its only):. _ Date leaving U.S.: <br /> ce 17.Taos-orterAdmonlodgmwofReceiptofMaledafs r <br /> rispoder 1 P me Signature <br /> Or. <br /> 9 &.z <br /> nsporter Y lRd r0dMilid Name Signature Martlt Y. <br /> 1S_13tscreparxy <br /> 18a.Dlscrepancy Indication Space ❑ Qu'* ❑Type ❑Residue ❑Partial R.I.-tion Ra)ectiou <br /> t F Manifest Reference Number. <br /> 18b.Altemats Facfy(or Generator) U.S.EPA ID Number <br /> L.. Facility's Phone: Monfh Day Year r <br /> t8c.Signature of ANemate Factifly(or Generator) <br /> H <br /> •' .19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,dGsposa1.and recyding systems) <br /> _.3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous matedats covered by the manifest except as nded in item 18s Month pay Year <br /> PrinledfftedName +" Sigreture <br />