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335613 nr..... .,e ... n...� /C...... d�n�,.,.�A Fn• um nn nlifn l79.nifn6l hennuxifor 1 �-47 q2�k4 33 0862 Fnrm Annrnvpd OMR Nn 7nim linin EPA 1-orm UIUU-22 (Rev. M5) Previous editions are ob V os kte. 10808.1551 ( DESIGNATED FACIf_IT�1'O DESTINATION STATE (IF REQUIRED) f UNIFORM HAZARDOUS v 1 • Genereta ID Number 2. Page 1 of 3. Emergency Response. Phone 14. Manifest Tracking Number 007752441 JJ WASTE MANIFEST 424-9300 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Felin Freight FEDEI( FREI6HT (STR) 4320 SOUTH HI6MY 99 FRONTR6E RON 4520 SOUTH 016MMY 99 FRONTR6E ROAD Gen 215 (269)456-2127 6. Transporter 1 Company Name U.S. EPA ID Number CENTURY ERMIRONMENI& BEGEMENI QE AD C CAR000164012 —2]s+ 7 er2 Company Name U.S. EPA ID Number eeVV^ ry4 LI/ 8.Designated Facility.Name and Site Address U.S. EPA ID Number*. 6ENERRL ENI AL 16T, LLC NO PSC ENVIRONMENTAL SERVICES 11055 UNITE ROCK ROAD Facility's Phone: 9a. 9b, U.S. DOT Description'(induding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Patting Group (R any)) Quantity Wt1Vol. ag 1• UN19SO URSTE REROSO.S, FLMILE, H.O.S. (LOOSEPRCR AEROSOLS) 2.1 DOO1 232 U2. UN1263 VATE PRINT RELATED MATERIAL 3 PGII RQ0001) D001 331 X be - pn'L 3.NON KRA HRMBOUS PASTE LIQUID (OIL) 221 4' UN1261 VASTE PRINT RELRTED HATERIRL 3 PGII R110001) 1001 331 X o 6r -1 1 14. Special Handling Instructions and Additional Infomwtion I1 G' a \ ;Lx 11) FEFRER2.1-00 - ER6(125) PRO# 2013526302 - RE (2) FEFVPRN-82 - E16(120) PM 2103112313 VPRRif (3) FEFNCHMIQ-00 - PRO81510697511-01 NO (4) FEFVPIMI-02 - ERG(128) PRO# 1913359476 VPRN 3 I X I - , / X f 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledfplacarded, and are in all respects in proper condition for transport according to app cable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262:27(a) (if I am a targe quantity generator) or (b) (if I am a small quantity generator) is We. Gen:o es Printedrryped Name Signatu Month Day Year e ie I iY I 16. International Shipments ❑ Import to U.S. ❑ Export tram U.S. of entry/exit z Transporter signature (for exports only): Date leaving U.S.: W 17. TransporterAcknowledgment of Receipt of Materials 12 Transporter t PrintedITyped Name Signature Month Day ' Year Z Tr r 2 Print Name S' re , - - =-M Day Year . Drs ncy 18a. Discrepancy Indication Space DQuantity ❑Type ❑Residue ❑ Partial Rejection El Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J V W Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardous Waste Report Management Methal Codes (i.e., cafes for hazardous waste treatment, disposal, and recycling systems) UJI 0 2. 3. 4. nated Facility Owner or Operator: CertificafibA31WAipt of hazardous materials covered by the AaWeept as noted in Rem 18a Prin yid Name Slignatum Month Day Year ter~ -- C 110124.1101 EPA 1-orm UIUU-22 (Rev. M5) Previous editions are ob V os kte. 10808.1551 ( DESIGNATED FACIf_IT�1'O DESTINATION STATE (IF REQUIRED) f