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Dec , 27 . 2019 10 . 43AMr No , 1481 •, . P , 12
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<br /> UNIFORM HAZARDOUS 1 . Gerleralor ID Number , Page 1 of 3. Emergency Response Phone 4• Manlfest Tracking Number pp e
<br /> WASTE MANIFEST t;A09Fl 116117! 1 ' iirlllxilar?�l 'o
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<br /> Generators Name and Ma IngAddress. fi ,. _ Genem(or's SlteAddra&a Ili different than mailing addreas)
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<br /> Generator's Phone: ' ?1I014 ~U�ntt
<br /> 6. ransponer1 Company Name irlat 5t< ri z 1 1 , % •• U,S. EPA (D Number `.
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<br /> l 7. Transporter 2 company Nara U.S. EPA ID Number
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<br /> HM and PackhIg Gioup (if any)) No. Type Quantity WiAtol,
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<br /> AttijSpeclal ,Honditngm InsidlonsandAddltionalInformation
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<br /> 15, G9NERA7OR'8/oFFER0R18 CERTIFICATION: I hereby decisre Ihet (he oonlents of Ihis oonsignmontsrs fully and amwale(y described abova'by [fig propai' sMp'ping name, and are c190160d, packaged,,
<br /> marked and labelediplacarded, and are le all respects in propar condaion for transport occord rig to appucabfe Intematfohotand national goyarnmental mgulatlons, if oxport shipment ends! am the Primary
<br /> Expbnei I ceglN that the contents of this consignment conform Io.lho terms or the attachad EPAAckn'wedgment of Consahi, '
<br /> I ceritfy that the waste mUdmizadon statement idendRedin•40 CFR 26227(a) (if I am a hies quantl(y generator) or (b) (Iii am i small quantity generator) is true,mm,ww '
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<br /> Maniteaf Reference Number: "
<br /> 16b. Allerngle Fadli(y (or Generator) U.S, EPA ID Number
<br /> Fad6tyts Phone:
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<br /> 10. Hazardous Waste Repoli Menagemenl Method Code& (Le•, codes for hazardous waste treatment, disposal, and racyding systems)
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<br /> 20, Designated Fadi ty owner or Operelor: Cari hcation of raodfpt of hazardous materiais ooverad by the manliest except as nded in (tam 180 '
<br /> Print iry ed Name • ' - ti . , %nature.. i abUi Dap: so•Yaer
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