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C__ "'easN pnrltc, . . r JJK -� 1 N <br /> l7Ntp qan. IV W <br /> O W-�4 MH His ,.cenerala ID Number 7 a la �r 3 E , � _ C (01 <br /> 9 <br /> l V!'nera[i a Q (Sl <br /> I-rs N CARO 0 0 0 7 a 5 e 5 Generaidrs Sue Address 1a Merenl Ihan mailing address} Q IQ Z <br /> O <br /> G YR.yr'Y T1L►ypT Address RD W (D Z <br /> IFRA_'4 j*14 NORTH IifiQt�fr C/] v <br /> ; E iil'fA0CA <br /> h r, Whore: U,S�EPAID Number 6 N <br /> Irl e;t Company Name 8341711 G A Q 0 2 9 7.7 7 0 3 CD <br /> 2 w, I'tD alt EMM P- �l <br /> 7 T,ar,sr;,",er, ROWINTAL SERVIGE9 U.S.EPA Vo Number n !? <br /> 0o'^Pany Name `O <br /> 8 U.S EPAI0 Number <br /> - �Faraty Nerve and Sire Address � <br /> bRLD Oft RECYCiUNG p <br /> N <br /> AL,MAE[al5 sT RE£7 ';A 40222 C A T O 8 O O 1 3 3 5 2 <br /> FacAl phone- <br /> 90 9b Ll.S DOT Descnpbon vndudmg Proper Shipping!Jame.Hazard Class.ID Number I U.Coruainers I t-Total 12.Unit 13.Waste Codes � <br /> HM and Paticing Group(d anYp <br /> No Type Quantity Wr Nor <br /> 1 NON-RCRA►�AZARDOLI WASTE LIQUID(U`: 221 <br /> r., O <br /> w o <br /> w N <br /> � o <br /> w <br /> 3 <br /> N <br /> a <br /> O <br /> 14.Speaai Handling lrslructens and Additional Information <br /> EMERGENCY CONTACT CHEMTREC 1-$00-4249300 WOES TERMINAL.:CERES CS NAERG* 1 171 "PROFILE N 961: <br /> 1rRA078-101419 USED Olil,'MIX FD OIL - -APPROPRIATE PPE EQUIPMENT � - �{ 1 y I � � X V, � <br /> Y Y Packaged- <br /> 15 <br /> Q <br /> 15 GENERATOR'S70FFEROR'S CERTIFICATION: I hereby declare that the contents of Ihis consignment are full and accurately described above by the proper shippingname.and are classified,packaged. <br /> marked and labefedlplacanfed,and are in all respects in proper condition for transport according to applicable intemational and national governmental tegulatians.It export shipment and 1 am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(III am a small quanGly generator)is true' CD <br /> Signature Month Day Year <br /> Generajor'V0ffero+'s Panted ryped Name igj <br /> l' _ <br /> 6.International Shipments Import to U S. ❑Export from U.S. Port of emirylexit. <br /> Date leaving U.S.: <br /> Trerlttiporter signature!for exports only): <br /> 17.7Yarlsponer Acknowiedgment of Receipt of Materials Month pay Year <br /> TrarspMer 1 PrintedlTyped Name'' Signature <br /> I } <br /> �' 'R Month flay Year <br /> 2 Prinledlryped Ni 4 Slgnalure <br /> Indication Space � Ouanlily ❑Type ❑Residue <br /> ❑Partial Re}ection ❑Fuil Rallection <br /> Manifest Reference Number <br /> to Number <br /> Generator) <br /> Month Oay <br /> qtr Generatori <br /> � Zl <br /> 0 m <br /> MW#iod Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) p <br /> 2 13. 4- <br /> on of receipt of hazardous materials covered by the manifest except as nded in Item 188 Month 4ay <br /> CD <br /> Signature cn <br /> cc <br /> v v <br /> M <br /> GEKERATOR`51N4T1 <br /> Cl) obsolete, °ADW° <br /> 0 <br /> Cn <br /> Cn �. <br />