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C— -0 CY) — <br /> CjI <br /> CI) 0 N) C.) <br /> , se 61 <br /> 0 0 N) <br /> z 0 .71 <br /> N) <br /> C:) <br /> > (D <br /> S�T ?�—We89146 M <br /> z —h <br /> > <br /> . ......1 6 11-2 2n elite 412-ot-h)"Mer) 2- (D <br /> ;7 2 P.q.i or Farm Appw,.d.OMH Hn 205r� — - <br /> Lli M 3 E—rpmq F�N—Ph— 4 M."i�tTwidN H,,�, SKS 0 0 <br /> M WASTE MANWEST C4 <br /> -r > <br /> Cn < <br /> U.S.EPA ID 11—h-, <br /> 1, 0 <br /> 9 EPA IU H—W, 3 <br /> U.,EPA ji <br /> F.6hi phore <br /> ga 9t JS DOT De,ini F,,­nmippir,Nam,H—N ID Nur,b", 1b CL <br /> and , _y 7,kai <br /> MM P.MN Group 0 12 Unit fa.MlaakCodesNo. Typo 0_0i IM r1a V) <br /> (D <br /> 3 <br /> rD <br /> (A h <br /> O <br /> O <br /> Ol <br /> 4 <br /> 14.Stecja!i Instructions and Additional lirfanallor CY) <br /> Uj <br /> IS Ln <br /> mv,�Wy de�,nbed;bttVth� pac�aqed, <br /> e fu <br /> GENERATOR'S,"Of IFEIRIOR 5 CLIKIIII'll r hi declare Thal the contends oiiij�his��n gninbillit!!'I ll y end <br /> ni and iabeledipil and are in all respells in proper condition for transport According to applicable intemaronal and national governmental reqUlaur)ML If export shnianrort and i am the I'Mi <br /> Exporter ION That the contents cfthrs consLormi n <br /> conform to the terms of the attached EPAAckncwled�jmenkofCVsenI <br /> i <br /> I certhat the wade minima itan sli identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ITI ami quantity generator}15 Inge. <br /> Month Ir <br /> Prmtecii-Evped Name signature Day LA <br /> 0 <br /> 15 Inter,00nalShipriLA <br /> LI lffpDrt to US. I=J EKp0rlfrom U.S Pork of ani <br /> Tra"i signature(for exports oni Date leaving U.S.: <br /> LL) 17Transporter Acknowledgment. ..Receipt o a Has year <br /> WTransporter I Prinleri Name Signature Month S)av <br /> eQ0 <br /> VIL <br /> 00 <br /> -M Trarspi Priptadi Name Signature Month Day Year S <br /> z 0 <br /> C: <br /> 0:5orepancy <br /> 8&Drscrepai Indication SpaceFull Ra�ecl;- <br /> Type Residue ❑partial Rela,ki <br /> Manifest Reference <br /> 10b Ailternale Fac'Jjly in,Generalorf <br /> D Number <br /> fZ <br /> rD <br /> Ln <br /> Faii Phone. Month gay Year <br /> 18c.Signature QlAill Facility for Generator) <br /> rD <br /> 19 Hazardous WasteReport Management Method Codes(i.e..codes for hazardous Waste treatildeni•dISPOsal,and recycling systems) <br /> 0 (D 0 <br /> O <br /> l Af hazardous materials covered by themanliest except as noted in Item lea 3 <br /> 26 Pasignafed Facility Owner or operator.Certification Signature Mcrililn Day YeasPrinitedi Name <br /> GENERATORS INITIAL COPY �0 <br /> T PA Form 6760-22{Rev.3-05) Previous editions are obsolete. 0 <br /> cn CI) <br /> (D 00 <br /> 0 <br /> 0 <br /> O <br /> Form_ <br />