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F � <br /> PJeasa,,,&or"a,(Form designed(a bso on elite(12•pitch)typevmtar.) Form Approved,C1M8 No.2050.0039 <br /> ` tiNiFOftM HAZARDOUS 1.Generator lD Number 2.Page 3.1 Emergoncy Response Phone 4.Manliest Tracking Number <br /> r <br /> WASTE MANIFEST ' , . <br /> 5.Generator's Name and MallingAddese {r:,° enerata s Slte'AddresS(IidNTereniw malgaddress} <br /> Generatoes Phone- "� al, � <br /> G Tmnspdderi Company Nama !' US,EPA D Numhet <br /> }t <br /> 7,Ttpnsporter2 Company Name i y U.S.EPA ID Number <br /> B.DesignatedFaa! .Nama and Sks Address I U.S.EPA ID Number <br /> r �w:` � r-�u cam•:, <br /> FedktysPhoner ar '' t :` <br /> Ba., 9b.US DOT DasttEpibn(hdudmg Properipping ShName,Hazard Class ID Number, _ t0:Contatnars, . ,,.11.7otai 12:,UnR 1I,Waco C*rtoa <br /> HM and Paddng Gioup(Reny}) No, Type.,. Cban* WlNol. <br /> y-t <br /> sr v: <br /> �[ <br /> t5: .480z, <br /> M. <br /> W <br /> 14,Special Hanong instructions and Addlilonal Inturmatlon <br /> r r8N 7 4s a. <br /> ME <br /> 15. GENERATOR'SIOMROR'S CERTIFICATION:thereby dad�re that the contents of thVcons�nmenl are fully and accurately desuibed shove by the proper stdgping name,and are cloulfied,pada , <br /> marked bad labooplacaided,and are in e8 rospecls kr prop candliop"Ia transpo ccorditg to applicable Intemationaland national govammentai regulations.If export twpa"t and I aim Cha Primary <br /> Exponier,I cortify t t,ft contents of this consignment conform to Cho to m of fha shad EPAAslatmtiSedgment of Consent <br /> i certfty Rtak the v~d6ts [rtlmiza6an sEatahtent laen��s`+a 40 CFR 262:27(a)(R l alit a largo quantitygon5rator}or(b}lit 9 om a small quenllty.goneralot}Is he. <br /> Gan r'a Primadayped Name fir: .�` iytgahae«� Month Day Yeaz <br /> -1 16.Inismalional Shipmentsr�-� a•. <br /> knpod to U.S. L_.t Expa1 from U,S• Pod if ar"I"L. <br /> Tptnsporter signature(for expojfs only): . Dale leaving US.: <br /> R= 17.TranspoderAdao.Madgmant of Re*t of Matetiats <br /> Transporter IPdotad(TypedName Signature Month Day Year <br /> X10R AtrviLA , ;� 1 <br /> 6-- Transparter 2 Prinledli'yped Nora Sklnature Month Doy Yeaz <br /> � l E <br /> d3lL i, a`'1�,ta .4 s Lam`• ;fes 1� "$ <br /> 18.Discrapan y -1 t 1 <br /> 18a.Discrepancy Indleatlon Space a Ou.My t t--1Typa t J Residua ®Pa'Mal Refection ❑Full Re oa. <br /> Manliest Reference Number: <br /> 18b,Atlemate Fealty fpr Generator} US,EPA ID Number <br /> -4- Fadity'a Phone' <br /> W Mc.Signature ofANamata Fad fly Genamian} Monti) Day Year <br /> d <br /> Z <br /> w M Hazardous Waste Report Management Method Codes(?a.,silos fq hazardous waste treatment,dtsposai,and recrag systems} <br /> b 1, �2 g�'-•y 2. <br /> 20:Designated Faa7Ry Ownor of Operab�rCedlBcatiott of rare�rk of h azard materials aivsrad by the manifest except as torted In Clam 185 <br /> Pri oma ]rra"'' 4 'Modth :D y Y at <br /> EPA Form 8700-22(Nov.MS) PceViot�3 editiiDns are obsc'ata. TRI:NSPQ�RTER'S COPY <br />