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L 'b 1 N <br /> v NW <br /> O O0 CYI <br /> D O Nz <br /> G _ o <br /> y (D v <br /> i <br /> v <br /> C1. 1V (D <br /> _ 1W8RTE r 8 t ee.'yruWr. - JJK (D <br /> W s ae+u,Nyy CAROOODf 9 n Q <br /> 1 mpAklp adtlrreq <br /> Will rl� <br /> � naalq,pp11111,111. CA 7d C <br /> a^�atirt. =Ca&tiFitil y <br /> US EM IV Number o <br /> �T L ftrjvKWNWAi 9FarMil CA D02 a 217036 <br /> U S EPA IO Mumber <br /> Nkn.aw sae us EPA Ib Nember <br /> WOOD 0a larmum <br /> 20M pill AMittifi S+r l <br /> ilp <br /> cCA 80221 CATO80O13352 <br /> pill <br /> 4e fh U la 00111"O Ml(-WN Proper Shll Name H—M Gays,lD Nwml 10 Containers 11 Tidal 52.u. O <br /> t 3.Wssse Codas <br /> NM .m Pad"raol4(W—Yl) Nn Type 0 xintrly WrNel o <br /> r RQ•t7f17.M 11l F"MABLE 1i N 0 S lGASOHNE.DIESEr, t7061 pplg 343 lV <br /> r" <br /> 3.PIG x w <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 1u S Hand6rg lnsbuctlans and Addl6onal lnfprmatron <br /> t wExamy C:oNTACT-CNEMTREC 1-800.4249900 WOES TERMINAL:CERES CS NAERGM 951 121PROFILE N 981'. <br /> •MM d49OIUNE,DIESEL• "APPROPRIATE PPE EQUIPMENT �I l � e 0 <br /> 15 GENERATOR'SrOFFEROR'S CERTIFrCATIGN:l hereby declare that the contents of this consignment are fully and accurately descIribed above by the pmpel shippung name,and we classified.packaged. YJ <br /> marked and Ubeledlplacarded.and are in all respects in proper condilion for transport according to applicable international and nationat governmental regulations.If export shipment and t am the Primary <br /> Exporter I certiry that the contents of Mrs consignment conform to pie terms of the aftl EPAAc¢howledgment of Consent. � <br /> I oe"1har the waste mrnrmrzatron slalement rdeitil rn 40 CFR 262,27(a)fir I am a large c lity generator)or(b)(if am a small quantity generator(is hue. <br /> CcnereforsVffera's Pnnled%Typed Name Signature Month Leap Year <br /> j . r�Lonal Shipments Import <br /> F6Merr ❑Impart to U.S. Export from l I� Port of enlrylexk- <br /> Transporter srgnatum(for exports ally) Date leaving U.S,: <br /> r 77 TranspdrferAckrawledgmenT of Receipt of Materials <br /> Signature Month bay Year <br /> Tra7apdrter 1 PnNtEd,7yped Name <br /> 2Pralted?ypedNa Signature Month Day Yeat <br /> - p0r'space ❑quantity ❑Type ❑Residue ❑Partial Relecilon ❑Full Re}ection <br /> Manifest Reference Nurnl <br /> jar Genemtn i U.S.EPA 1D Number <br /> trl:aerrraalOfJ Month Day Year <br /> hlBtlrod Codes{l codes for hazardous waste treatment disposal,and recycling systems) O (D <br /> n <br /> cc O <br /> v Q <br /> r of recall of hazardous materials covered by the rnani4esl except as noted in Item 1 B 2 ' <br /> Signature Month Day Year <br /> �J <br /> CD <br /> Cn <br /> obsolete. GENERATOR'S INITIAL CM <br /> N <br /> 00O <br /> C)"! <br /> it <br />