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pioase D q it ar tv ce f Form •Jesia F%e i_ i_,r �:, i ve; <br />Form Approved. OMB No. 2050-0039 <br />kPa Previous Ad ;Ion: are, obsoiete DESIbNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />JN�16RM HAZARDOUS <br />77 <br />Pr. �mt <br />4. Manifest Tracking Number <br />018529245 JJK <br />ASTE MANIFEST <br />.5 GO, <br />Generators Site Address {if different Nn mailing address) <br />Gen:. ci %t <br />6 <br />U.S EPA ID Number <br />7 Irip,spiler <br />2 E',GTpa?)y Name <br />U.S. EPA jl) Number <br />jL <br />8 0 <br />9,gnFktQd ra6iq Name and $ie Addrasr, <br />U S. EPA IQ Number <br />p h Ono <br />Ga <br />?lb _! S bQT DcsC.r,:)fion )L%ad irj P! Df;B: S h�rp.r i(: <br />Nar ip H4za rd Class. 0 NijmbC'- <br />_-,n[ainers <br />li Total <br />1:2 Unit <br />13. Waste Codes <br />ND. <br />Type <br />KM <br />and 93c�,ng Group yif anvj! <br />Quantity <br />WtIval. <br />0 <br />4 <br />14. 2.: i?and I ir; g fns Lrucisoihs and AddtliorLa I Information <br />kV 11 —31 Z C <br />1i <br />G E N E RATGR'S!0 FF ERO R S CERTIFICATION <br />e that he i�-,Rtenls of thiszonsionment are fw![y and avcixately described above by the proper shipping name. and are classified. oatkaged. <br />ondition for rw;spor, a=rr.Ling 'r. 80pl4cab* nwnaLicrial sad n,)'.;Qnal governmental regulations. if export 0igmant and I am the. Primary <br />Exporter. I certify that n <br />Awarri) ic the lerffis of Phe attached EPA AckNywiedgment of Cor!5e.-T <br />I certify that in& waslE .......... , 'il <br />r 4r:P - 262.2?p) (,t I em a 1;1 rge ,, u an My genemior, r.r iff , arr. a 5 mai I quantity gerieratoo is true- <br />ff -T-r;,'i <br />Month DayYear <br />jI 'Q'A t. U.S. <br />EIL Exportfirorr. ..S Py: <br />Transporter=up:iaTve (tor exports only): <br />D if, 9 'J. <br />Ll <br />1'i rrad :spone i A�.nomectnmenl alf ,Receipt of Mat09^ <br />t2 <br />Trarip a Pdnted.'�. NSignature <br />f Month Day Bar <br />0 <br />in <br />7 <br />D Y <br />I aa i0,scr,p ricy Ind rcaton Spa,:e <br />Quantity <br />Type I ❑Patal Rejectm, ElFull ❑Rqection <br />Pel2�!test Reference Kun-'bev <br />aCii IV X <br />U.S. EPA 10 Number <br />L)• <br />Month Day Year <br />S2"0.1 <br />far ii%zwuous waste n .,! g sysierns! <br />LLJ <br />. <br />L <br />ten acdtty Owner or Opera t.-, r. F. m 'aceipt <br />of haaardoc;6; iawjals covered by the nanjfp,5.1 exc' As noted in Item 18a <br />Figriat rE Myth Day Year <br />4 <br />1 <br />kPa Previous Ad ;Ion: are, obsoiete DESIbNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />