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C— –d — N <br /> v NW <br /> O OCYI <br /> p N z <br /> epnnta ,ca,,,, (D Z <br /> r1A2AgnOl16 v,:ra^10 k,::,<.. � <br /> WWTE fAANFEST <br /> f=y^«>eThwCD <br /> r..n..a-yCD <br /> us. SIO Nwnhur p <br /> `C <br /> us EPA in Num— ,--h <br /> �+rA1b M1Onr♦+nrt n'rr iv.t,es° a S.EPA to Numhei p <br /> stear, "d".1 Sr,11,-+p NameH,unrd 0655.ID N—Del 1n.Containers 15.Total 12.entt 13 wr3Sm ci de; <br /> n! <br /> No Typr. eJentity WINaI <br /> I <br /> C <br /> O O <br /> K <br /> W i O <br /> tS <br /> f � <br /> 0 <br /> 14 Spe-rx'H,6 n3 irsrnr[lrenS ane Add,liUnal informalicn <br /> O <br /> r--F <br /> O <br /> GENERAIOR'SAPFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately desenbed above by the proper shipping name,and ata classified,packaged. <br /> c markec and labeled/placarded_and are in all respects in proper condil for transport according to applicable intemalionaland national governmental regulaGone,If expod 5hipmen4 and I am She Pnmary <br /> Euporter.I certify that Ne contents of this cansignmenl conform to the terms of the attached EPA Acknowledgment of Consent_ p <br /> 1 cer*that the waste rnmlrrliZadon statement idenliAed in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(N 1 am a small guantlty generator)is Irue <br /> Generafors=Oh'eroes Priated;Typed Name Signature Mon1Yt oat Yeas Vj <br /> CD <br /> J Ifi finemabonal Shipments <br /> Z ❑import to U.S. EJErport from U.S. fort of entryleKis�, <br /> Transporrer signature(for exports only): Date leaving U.S.. <br /> � r7 TransponerAcfnpwledgment of Receipt of Ma?erials <br /> Transporter 1'11med(Typed Name Signature Month Day Year <br /> O <br /> a <br /> Transporter2 Pdnled(Typed Name Signature Month Day Year <br /> lis DIsG-epancy <br /> 168.Discrepancy IndicaLon Space ❑Quantity Type Residue ❑PariaRejeon ' <br /> Full Refection <br /> Manifest Reference Number. <br /> A�rrfate Fadlity Or Generalor) U.S.EPA ID Number <br /> a&Wily for Generator} Month Day Year <br /> Report Management Melhod Codes(re,codes for hazardous waste treatment.disposal,and recycling systems) <br /> 2- & 4 <br /> .(l <br /> ar Operator Cerllficat Orl of receipt of hazardous materials covered by the manifest except as noted in Item 183 p (D <br /> n <br /> Signature Month Day V 0 <br /> editionS are obsolete. GENERATOR'S INITIAL C <br /> 0 <br /> 00 <br /> CD N <br /> r� W <br /> 0 <br />