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L "d 1 N <br /> a) Nqo <br /> O 0 CYI <br /> D O N Z <br /> O <br /> v <br /> 307 <br /> JJK CO Z <br /> (D <br /> IT m <br /> U) r�0 <br /> - Ila F3A I(Nlrmtvr <br /> fT7S�+77.fpSD <br /> � �rLS.Od{L'te*�(Ir4'Nvrrpw�lppi.]Q Name Na2?rQ Ubss.Ip N�mtw� m c-lnir— t1 TmW N.-!rraes <br /> " a•1fltirYp ratatp Ratyp Nn Ty U:. uanti1Y WI MM <br /> w. <br /> 0 <br /> 'rJ <br /> � O <br /> r� <br /> S � <br /> J <br /> a � <br /> W <br /> O <br /> - },( fis�$q and Addrb.nnl lnlormaao. J <br /> 1 <br /> 5. GENIM7(M-SCFFEROR'S CERTIFICATION:I hereby declare that the contents of this wnsignmenf are fully and accurately descnbed above by the proper shipping name.and are clau+<lad.packaged. 0 <br /> .wIFPd.beladeplaentad.and are in all respecls in propere-dition for Iransport according to applicable Memetional and national governmental Tegulations,N export shipment and 4 am the Primary t--r <br /> E,gXvtar I ce"that Vle-merits or this conslgnme.f-.form€c rheterms of the attached EPAAckilmledgmenl of Consent 8" <br /> ceddV duet the waste minimi Gabon statement identified In 40 OFR 282.27(a)lif I am a large quantity generator)or(b}Iii I am a small quantilY ge-awl-)is true <br /> Cw]ar�oYs101gerues PnnPed/Typed Name signalure Month Day Year <br /> ]6'NaFraitwO Shipments fmp.d Ie Ll S. ❑Export fmm U 5 Fad ri entryter.n <br /> Ttangodr�r Wialrae(for exports wly) Date taWnS U <br /> !7 TraistraarferAckrlowiedgmenl ofRece,'pt OfMafami s <br /> I Pnntedi Typed Name signature Month Oay Year CD <br /> 2 PnntecaTyped Name signature Mnnlh bay Year <br /> Irld Gabon Space ❑Full Re cn <br /> ElOuanlity ❑Type ❑Residue ❑Pal Rejection eGo <br /> I <br /> Manifest Reference Number, <br /> (or Generator LIS EPA ID Number <br /> Facifity(or Genereforl Monm OBY Year <br /> Afivi meat Method Codes(l e„codes for hazardous waste Ireatment,disposal,and recycling systems) <br /> 2. 3, 4- <br /> i etetor'Ostfical on of receipt of hazardous malerials covered by the manifest except as noted in item 18a <br /> Signature Month Day Yeas <br /> � Zl <br /> s are obsolete. GENERATOR'S INITIAL COF o n <br /> cc O <br /> v a <br /> O <br /> v <br /> 00 <br /> (D 00 <br /> N <br /> CO W <br /> O <br /> rs <br /> rs <br />