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C— "d 1 N <br /> a) NW <br /> O O0 (� � <br /> D O N z <br /> O <br /> sv cfl Z <br /> CD <br /> IT! CD CD <br /> Q <br /> t a a 4 8O o 7 y a T rrvPs rrs sono O <br /> twN"i,AwdIE nu <br /> +wit tr +evn <br /> -'�k'{3113 <br /> WCW&Q tYt t r'^'yurNyyJ MiMrMr r- r Aro�+:A: ro s!s <br /> �w <br /> AF:lJo.nt7•,a�:- <br /> Nese.atl sr eAe...e a s.evalo Nwwer � <br /> 77 A�g1,11e�s,M1.YI .A <br /> ='ft- - _ TI <br /> fM m US OO rlaroralbrirNhserg Roos 9Nerrie,llaaere Clara.lO Numher. Ie.Cmrd,ne•a 11.total 12 ane ry wadeG o, O <br /> syr rrM�ryar lR anll Nn Type Warmly Nn Nnl <br /> {fir <br /> tl <br /> _ W <br /> Lti <br /> Lti <br /> �/mar I�d^r�rry'i"s!'r+�'Pns and/ddrlinnal Inlomration O <br /> r--r <br /> _ O <br /> 15 GENERATOR'SIOFFtROR'S CERTIFICATION:I hereby declare that the wnlenta of this consignment are fully and acwrral.Vy described atove by the proper shipping name,and ale dassified,packaged. <br /> nuahed and la8ekdlpl8cardad,and are m all respects in prayer"Oban for transport according to applicable Inlemabonal and national governmental requlatons.U ewml ahipmenland I am she Primary O <br /> E.morrer.I certify Her the worrenis of this wnsynment conlolrn w the terms of He attached EPA Acknowledgment of Consent <br /> os<bN Hat the waste mrnimizabon staWrnsnlidentified in 40 CFR 262-27)a)(of I am a large quantity generator)or(b)(AI am a small quantity generator)is True. <br /> �raeralors101re+ds Prinledrfyped Name 5ignature Month OaY Year <br /> s--r <br /> 5D <br /> 1g Mtt'rmdnl0 shprnents ❑import io It s. ❑Expwf from U.S. Port of antrylexit. <br /> Transppler synature(for espons arll yo. Date leaving ll.5.. <br /> 17 TmnsporterAcwomedgrr 1 of Receipt of Materials Month Oa Year <br /> Q TrshelsorW t Printedrryped Nam 5lgnaNre y <br /> Q <br /> d <br /> �4 sanspoP.er 2 Pante64yoed Name Signature Month gay 'fear <br /> F <br /> ?3 Jso esa^ry <br /> 754➢Isc-,,,ncy InchmDon Space Ej ouantity LJ Type ❑Residue ❑partial RL}e ion U FuN Retied on <br /> Manifest Reference Number. <br /> 166.,4f>prnafe Facdlry(a Generator) <br /> l},5.EPA 7D Numhes <br /> Ph". Month Day Year <br /> orAltemisw Facility for Generalorl <br /> Ilfn�e Report Managameni Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. 3. 4. <br /> or Dperalor.CerGBcatron of receipt othazardous malerials covered by the manifest except as noted in Item 18a <br /> Signature Monih Day Year ;(l <br /> O (D <br /> Cc C) <br /> � O <br /> v � <br /> ed6ons are absolele. GENERATOR'S INITIAL CC)P' E Q <br /> .. o <br /> O <br /> v <br /> 00 <br /> O N <br /> Cr W <br /> O <br /> rs <br /> rs <br />