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<br /> Please p-in!or q'l;e Torm deswnac for use on eAe i12-HiW0 ty�mwfllal i Form Ap_.Tovcd OMB No.2'350-0039
<br /> 1.Ceneralor ID Number 2-Paige i d 3 Emerger:cr Respyrsn Phrn,c <.4fanifa5t Number
<br /> UMFORM HAZARODUS r•"
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<br /> I ga 8b.U.5.D07 Doscnption(ndudlra Proper ahiooinc Name,Hazard Class,ID Number, --10.contsi`an — 11.Tufal 12 U,nit 19.Waite Ccdes
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<br /> �i 15. GENERATOR'S10FFERQR'S CERTIFICATION: hereby declare that the conlanls,�i th's pnsignmanl are fully,r,r1 acix,ralely described above by the paper shippltg p^"g
<br /> y marked and ianelediplecarded,and are-iall raspe= proper andihon for lrsnWrt according to appluble International and rallonal gohemmerlal regutefrarrs.If oxportshipmentarid'am the pr maty
<br /> Exporter,I cert f';that the coniens of this comigrvnant wnlarm to the terms of the attached EPA Aclmavindgment of Canserd.
<br /> I c•:gity that a ,waste iNhirnmalion statement idenifF&In 46 CFR 262.27(a)(if I am a large g,Ia-f,ly_xmerulori or On)41 I am a snmr quarMy generzlxj is hue.
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<br /> 16.Inlernationsl Sd n,e I I� from
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<br /> Transnndar sinalura�for axoans oniy): _
<br /> 17.Transporter Acknowk-dgmp It of Receipt of fdelerials
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<br /> CS2 r9.hazardous Waste Raport Management Medrod Codes f e,codes for hazardous waste treatment,disposal,and raryycling syalamt)
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<br /> 20.Desi-. ed Fad%,Owner or Operator,Cert fraVw gl rEnipt of hazardous ma'&W.S coyered by tha manifest except as anted In lit ro?Sa
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<br /> EPA Farm B700-?L,r 9-05) Prrvmus ea ;nrr;are obsolele. _ ^= s,^f: G MCll_I TY TO DESTINAT,01H$TV,E jIF RBCUIREOI
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