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3927 East Clark Drive PR0514138 <br /> October 10, 2019 Program: HW <br /> PHOTO 200: O'I�I absorbent and debris dis osed of as hazardous waste. <br /> IWASTE MANIFEST ,.cernmrorw NCaNAN "373 ..— zv1T Empgnrq.FxW^➢eP <br /> a�M 1oll�a/bx*bo� c e"O Ire Amermeln amaranr o wTrw renPmy, <br /> 3=7 Cam*asi.. 3227 a� sa mela,q meme,I 23a..� <br /> etoatw, v <br /> 56z" aborekby �w <br /> caeraw:Pno.�: _su-_arcs — - ca �4z sy9 <br /> er I .amen ft-ft <br /> N rM2C <br /> PF Nene U.e.EPA m Numpsr <br /> 9.DeagwntlFmihO Narre am Sae AOOmss U.S' um <br /> sm 6. 1 atm U.e.EPA 10 Numpar <br /> as,, as aa3aa — — <br /> F s P1rarle' <br /> 9 Wasm SNGP'PP Name aM Oascnplion 10.W0106111111,Mai" ConIallWra <br /> ae <br /> albs) (04>t3 awa2✓b2ot Aid Tyoa oln"°N 12.11 <br /> 3 <br /> 4 <br /> ,a spaaat Nandnna Imbactprx5 atMAtltliewlai mromlaaon <br /> CI-ALimt *-ms <br /> O�'�"��1747$1b, IND 31634das a[ am*+se <br /> (see) <br /> 14.GENERATOR'yOFFEROR'SCER7IRCA'—, <br /> markedantl labeled/placarded,arM Grein aN ha/eby tl�gg tUB Cpntem& this Consignmem ar Ially arltl aCWrately tleSMbeE app <br /> GerretatwapXemrs Pooled? resp IN Fmper condmon for hansport accorctin:to applicable international �bymepropershi <br /> Yped Name and naam al T41tImmmc tel re PI"name,antl are claeSifieQ pas <br /> SigryWre gulatians. raged, <br /> IS.Inemain nal Shipments - M <br /> ce�Import to U.S. Export from U.S. Day Year <br /> iter 'nature fore <br /> .TmnsporterAckrp-W.dgrrrent of Resat Port of enWaxit: <br /> nsporterl Pnntey(yow Nam pt o/Matenals Date leavi U.S.: <br /> Signature <br /> rporter2 Pnnled?yped Name M e.Y Month Da Year <br /> Signature g 10 <br /> Clepa Cy <br /> Momh DaY Year <br /> lnepalicy 6Micatlon Space <br /> ❑Guantily <br /> ❑iype ❑Residue 11 Partial Rejection ❑Full Rejection <br /> ate Facility(a Generator) <br /> Manliest Reference Number <br /> Ice: <br /> U.S.EPA ID Number <br /> 01A@emate Facility(or Generator) <br /> Month Day Year <br /> 2*0" or Operator Certification of res <br /> e Mariais covered by the manifest except a din Item 17a <br /> 19 lure gnty D Year <br /> MIS7(Rev.9/09) <br /> DESIGNATED FACILITY TO GEN ATO <br /> Lydia Baker, REHS Page 38 of 39 <br />