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y ). <br />a <br />s r. +� <br />:: S :NQ AZARQQU8 ..:: <br />1. Generator iD Nurnbar : <br />2 P s 1 ai <br />a9 <br />3, Eme a Hes <br />B ncY panse:Ph�se . <br />4. Waste Tracking Number <br />:. . <br />_.S <br />b Gsnera{or a l {moi®e td:Mai9ng <br />Address'. <br />3. <br />ion <br />Generator's. 800 ss (g.: ient t <br />ehsh MaIM9 address). . <br />I�R4»1�lta�"�s;.:�'�► �c .2rm+�o:a�q 'Ek��S=: .' . ' <br />'. <br />�'• ;; CA X453 IN 020811.7. <br />7 5 _ .TRWT �z _ <br />Gsseratar'sPharie; • BT.7. 38�-f►Q � '.` Attn: CA 9537+6 <br />■.: <br />6.. Transporter i Campy Name :. <br />U.S. EPA ID Number <br />_ <br />.:ADAM SERVICES, INC !�€]�8�Q3� <br />i; Trarorter 2 Company Name <br />:... U.S, EPA ID Nurirbar, <br />Dw ... . Fadgty Nerve and Sid Address <br />_ U.S EPA ID Ndnt <br />1KIM— <br />iiA, 'GA .. 9170 <br />F <br />sPhone...A2A, Ba4 "..... ' " <br />I Waste Shipping Nae and Desds tfcyt <br />t0: Cnnlafners <br />11.I0tal <br />12 llNtNow <br />IMIARUO <br />NCRUL&S •.�~...{ <br />Nn: <br />Type <br />u <br />Q , atitity <br />WtJ1id: <br />• .: ; , . <br />1 fs�m EST <br />i_Y��S�... V NRIS'! <br />• <br />} <br />7 <br />,: .s-'T4P4dRy Aer1. lM.k,. <br />i+ ^Sd r--,{xr_ •.Jed <br />n"i <br />t <br />�� <br />�X <br />��i <br />�A r .'��' ��•" �:'i'""""'�" <br />13 andel H nq tf� ns ars! Adds ktio on • <br />Arimt-1. PIN <br />FL�'Et-fit P�s227S <br />,a <br />>14, GENERATOR'S(OFFERgR',S.CERTIFICATION::I hereby. declare ft the Mentdat this. snent are fugy arM amaately dascdbed above . the erahl h <br />' p g name, <br />AroP <br />grid are desslQed; ° d, u•. <br />i. <br />. ";:;rrtarked'anrj lata package <br />tetNpfaaarded, and are.tn �i respects in inoperc lgndar transport according toAppgcabte tmernMonal national gevmr neat <br />T <br />mm-:. <br />Generateeted/%d Name . <br />�y�r S�ature <br />�hJi� <br />- <br />`ear <br />fP <br />18.:1�s Shim - <br />a `• S. <br />it <br />h� •lJ 8. <br />®Export fran Port of <br />enlrry/e:dt <br />T r S nsksre"for' `•• <br />_ <br />' Rate leavin U.S,: :: . <br />t6 Ttanspotter.�cknaia(adgmegt.ei Recetptaf lu�tertals:.: . <br />¢. <br />'T. rt pdptgd/i rw ure <br />�� <br />Tr.�porter2 Pdnied/Typed � <br />" T' <br />Nam agtmture - <br />' <br />t�aiiUr .Day ' : Year': <br />:-17.'Risc <br />•1xp <br />"l Spare <br />Qa O � Iie�du <br />' e ° � Pari�t <br />,�,,�• ftiod. <br />$'f <br />17b,:Fdtemate <br />- Ma4es4 Rateinsiva Number, <br />Fecglty (9r,C�teiatdrj ..::: <br />1.,U.$ EPA iD Member <br />:r�:.Fap <br />ePharre:• <br />- <br />1,c. <br />5 . ahxsa nf'Agemate Fecg . oc�Y. <br />....... .. ...... q5! ( enaraUor) ....... " <br />.'MaA <br />r <br />`i <br />y ). <br />a <br />s r. +� <br />