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- _ _ ___s_ >_ ---.a <br /> •�-;--. <br /> Pleas9 j'nn[w pe.' Fwm Approved.OMB No.2050.0039 <br /> UNIFORM HAZAROOU$ 2'Generamr lO Number 2.Pa8a1 o! 3.Ema'ymcy Response Phor:e MR IMat TraN Number <br /> WASTE MANIFEST t;..YfelY.:liY'.e:'£1f^iE '- 0. 0 2 3 3�3(J O$ JJ K <br /> sGeneremra Name ane Maning Aaares � c�wrmamra slm Aearee¢greixe.em Nen malMe+aerea.) <br /> -0E2ITxoPYn.:�n:e sTe.,-ao;_ < oc,rnpH-ay <br /> 'e32V VY W.-s Nf;:GTLfPI .5 j-. <br /> .JrOG1GF•)ftl.Ci-. 39':frs <br /> Generemra PM1one'n�- ' <br /> B.Tmn¢potler 1 Camparry Name V US.EPA IO Number <br /> 2.af✓.-Jc EM:Ir.CH3p.1ci.DV.L 9E1�:✓IC-_"S h.:C. <br /> .�..iula�w:ss-s, <br /> 9.Tr+napu'tar 2 Cwnpany Name - U.S EPAID Numbery <br /> 0.Deslgnelee Fatlllly Name aM 91te Aeeme V.S.EPA IO NumhM <br /> aRgFiLi ci.:r anOlyLIEiNTPi SER*t4F_9 I1'!�_ GialYr.klLx+.ri5E <br /> 'hYS SOUTH RIVEN RD. <br /> i`fEL_T SAv^RRMEN'iU.f.,A 5£2.L1 <br /> Fedll 'e PM1omyi 5-s]1�b-J+2] <br /> ga. 8b.U.S.OOT OexdpYm 01rNutllnp Pmgf.Shlpplrg Name.Xuare Cbea,lO Number, a.Cmhiners 11.Tole1 12.Vnit <br /> HM eM PaMYiB Gmup(tl any)) Ne. TYPa Ouantlb WtNol. 13.Waem CMe¢ <br /> y. f' IUY51U FV'2✓n i'1."a.J�R000S WASTE SULID (OIL,pEpRIS) .pS+� S ?5,_ <br /> O <br /> s. <br /> u.spaem I;.neeng me one mm Aeemw.l Ipr¢m.. I V 3 � +� S S' `J o� 2.o Y'1�-� - <br /> 3EI-4)PROF1LEft ERIXiIJE I�C S/�de�0 '-' <br /> L'.R. CCYN'fFfA4'i(:1R: FtAMOS ENVHiCJfeMENTA3. ' <br /> FiAAIOLER9 �sHOUl.O 6E TFLiM1ED iW0 135E ?PPffrJVE6 PFc <br /> 16. GENERATOR'S/OFFEROR'S CERYIFlGTWN: IM1meby decbre Nal Ne wMenm of Nm eonalgnme reNlly endewrably dasanLee show by gp proper a111pping nanw.mtl are Gesslged.petWegee. <br /> m+er+tl eM labelatl/placareee,end ere In all respect in pmpar rvndWon for 4analcrt a¢areing m eppllcabb NlematlanalaM netlonel goyemmenlel reyulelMna.xaxlgrt aM1lpnant antl I am Ne PM1nary <br /> Exparter,I mNIN N enb a2 Nla wneygnment conmrm m the mrma at Ne eX .Ired EPA Ackrvwletlgmenl of ConeenL <br /> IceNty NM Ne weale min numllan ahNmenl leeMnee In 90 CFR 262.2J(a)(Illamvlerge puentlty germrelor)o�(h Itlameanwll nIIN perejgljJD.bw. <br /> GeperOrq's/Oxero�h/Prinletl?yped Nama 8nehf re/ � Yay. <br /> 16.Inmrtmtlanal SNpmenm OIm1dHO U.S. �Expex M1am U.S. Port pf hyh il: • <br /> T2n¢pxler¢Ignelure((w axpwla enly): Ovle leaN.q V.S.: <br /> S 1].Tmnapormr AtlarosAatlBment ar Ra¢Mpl of MCMllele <br /> TreneParmrf PrinmtlTYp�d'.wJ@ SI Mm M�N pay Yrev) <br /> o �. 4 +=�- �....%a k-�� L.T��.P ��` .lea w.�_. `.-� <br /> msPo er n pep Name SbnaNre - MmN Day Yevr <br /> .F ,a.Di¢¢ravan¢r <br /> 19e Olecr+panry lndi®Ibn Speee O pwrWN DType OR.a+da. QPertld Refedbn QFUII Relectlon <br /> Manxvel Rrm nu Numhes: <br /> 166.Altemela FaziIN(or Oeneramrj V.B.FDAID Number <br /> r U FeaIYN'¢PM1o1m: - <br /> 10c.Slgnemre o2Nmmam Faciury(ar GenemmN ManN wy e <br /> 18-Xai+rticu¢Wum RapoM1 Management MCNae Lade¢Bs.,cWm lar M1essleaus wa¢te aeelmeM�tllapoael,arM ncyGing syamrre) - <br /> p 2L 2. 3. 8. <br /> n eme i I l bl\ <br /> 2D.oeelgnvlae FaGnb Ow*lerar OpMlq:Cepgcallon o(remlpte/M1eeamoua rtmmllale maered M Na manlfeat exwpl ea nrbtl In 1mm 10a <br /> X <br /> � grmmra Monty Dq Yeer <br /> L. ... ._...1 I_ ._. � -.L-. _ _ -_-__ 3 J <br /> EPA Form eyoa-22(Rev.12-, Prevbuaetlmarm are obaplem. ESIGNATED FACILITY DOPY <br /> IF VOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE aMANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. <br />