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L _.-._.-_...__ ar -0 O) N <br /> .OMR No 205n-0039 0 N N <br /> z Please print w Ivpe.(Form designed for ub'on eIat t 12-pltchl typewriter I O <br /> . enera:+Ir•Nnn•nrr Y.Papa 7 M 3,Emergenl•V Raat>anae Phone 4.Manr}eal Yraelr�Nymher � O C <br /> I UNfFOAM HAZARDOUS IGl •• •% <br /> G) F WASTE MANIFEST <br /> D Gnnn,:i., „+n1.i:!+',.roar:.:, Gene ators Sire Address(if dilrarent IN,mau,ne ad ress} <br /> fr O <br /> 0 <br /> Cn <br /> D F (D <br /> z - G-'.Wrs Pnone: U.S.EPA ii Number <br /> 6.TranBparfar 1 Cn�en, (D <br /> M 7R!rt. . ZT <br /> U.S.EPA 1O Hum9nr A) D <br /> Trarrspwter2 C.^n,:ice,N-xrnr N <br /> U,S-EPA rU Nmts <br /> uer i <br /> B.Lias imd Pea�,n N ,:c,•S,rr ai_ae=� Q <br /> r O <br /> Facitrty's Phone. 1 G <br /> 9a 9h.U.S.D070ascnp,e�ri::n;luirq:Roper Shlpping Name_Huard Class.lb Number, t0.Comainers 11.Total 52.Uaii Cdv <br /> 53.Wase oes <br /> HM and Parking Groep iii,ri,:i No. Type Ouanlity WINO Ln <br /> r--F <br /> (D <br /> o 3 <br /> C � <br /> aK � <br /> w — <br /> f1J (D <br /> rrt <br /> O <br /> 00 <br /> Ln <br /> W <br /> O <br /> a <br /> N <br /> — U•I <br /> 16 Special Handling instructions and Addltionai Information <br /> O <br /> 3Nf7V IM' (D <br /> GENERATOR'SJOFFEROR'3 CERnFfCA710N:V hereby decrare that the contents of thls consgnmeot are NNy and accurately tlescribed above W the proper stirpping name,and are classrf�ed,pa�'Raged, G <br /> m ENE arM rabe.'edFFER rd�dR'S and are to aft respects m pmper enndiuon for transport accortling m appl,cahle international and national govemmentaV regulations.It export shipment and l am She Pdmary - (D <br /> Expwrec I�rafY(hal the contents o!this wnsignmenr canlomr to the terms ofthe anaehed EPA Acknowledgmento(Consent. <br /> F t am a large quantity gammtnrl or(h1(il I am a smap quantity generator}is ora. <br /> rr2rary D5al Ne waste minimrzarionafemerrr fdendfied <br /> in 40 CFR 262.171af(i MOMh Day Year _ <br /> Genera 'Dn ors Prtnfed,'Typed Name Signature r-F <br /> O <br /> .� rF.inlernafronal Shipments ❑Ex ort from U.S. Part of entrylexit: <br /> ❑ <br /> import to U.S. P <br /> Transporter srgnarura(forexpons oniyp. Date leaving U.S.: v <br /> Q <br /> � l7 TransppRerAcknowledgrnertr of Receipt of MaEeriafs (D <br /> Transpoi r PriniedrTyped Name Signature Month Day Year Ln. <br /> O � <br /> a O <br /> Q Transporter 2PrinteCrypedName Signature Month Day YaarrD <br /> j <br /> � Q <br /> F <br /> 18.Discrepancy O <br /> IBa.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue ❑Portal Rejection ❑Full Rejection •G <br /> Manifest Reference Number: <br /> 181c.Alfemafe Facility for Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ra Facilit}fs Phone: Month Day Year <br /> W &i of Agerni Facility(or Generator( <br /> H <br /> a <br /> z <br /> 0 15.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems} <br /> 6 7 2. 3- 4, <br /> 2G Designated Facility Owner a operat(n.Certdicabon of receipt of hazardous materials covered by the manifest 9Keapt as noted in Ilam 188 <br /> Pdntodffyped Name signature (0 0 <br /> ERATdR'S INITIAL COPY Q <br /> EPA Form 8700-22{Rev-3-05} Previous iare obsolete, <br /> v <br /> 2 �k <br /> O <br /> Cn <br /> QJ W <br /> c0 rn <br /> (D N <br /> W O <br /> O <br /> W <br /> O <br />