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C_ -0 CY) — <br /> N W <br /> Oo se 61N <br /> Z mom <br /> G1 o <br /> m <br /> D Form Approved.01,+6 No,2050-0035 (D r7 <br /> please print 1t e.IFormdesigned for use on elite l lZ-nil:hi i.,e�nntcil � N <br /> z 1.Generdl0rlr]Numfier r,y.I�I l EmerrggeenLyReSnn�sr. . �" 4 ManlreatTraGklnpNamoar SKS — Q <br /> .. ORM HAZARDOUS J 1'HIOQ1-'r r 16 k,t 6 2 3 7 f_. K O_ (D <br /> WASTE MANIFEST <br /> m J <br /> .r.�ror,ry,ele and l,railrr�AadrY<i O <br /> Gen9fBlorl Slle arlM1r•�:' �ill�ronl than mailing atltlra951 O <br /> _ D <br /> cn < <br /> CD <br /> Genenb+k Phone: US,EPA In Numbe[ <br /> 6 T 1 Y Nan.• <br /> sS9a `TY�'F t <br /> u.s.EPA1D wumaer <br /> 7 ransgwrar z Company Nam? O <br /> 8.peslfpla[etl FaWily,Name a.,n. „t•T.-_. <br /> U.S.EPAID Number 3 <br /> S <br /> sy <br /> N <br /> FnIii Phone' <br /> I I <br /> i <br /> t <br /> C <br /> 10 Containers ,Tow t Unit 13.Waste r odea Q— <br /> ea Ab U.S.XT Uas optica lin iuding Proper Shipping NamB,Hazy tl CI85S,!D Ni0iWt,Nol. o <br /> HU lling and PaGroup ltl any)) No. Type . <br /> f+ V) <br /> I)viI Es 3'rc <br /> sj4 DS CONTAIN!":' V)o N.O.S., (G; <br /> 0 <br /> r-I• <br /> ? fD <br /> !v <br /> -tic+S tit 3 <br /> r6G25E '_a � <br /> i1"11 <br /> r7+Dt2 r_a <br /> 001 <br /> aD ty '34 -1 <br /> 14.Spec+al Handl Iml-uctions and Addilional Inrermatim 51233 34 tT <br /> rg3+9 r>s - N <br /> 0526 +3M1 V <br /> - =5 '34 N <br /> aa' c <br /> ge N <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION',I hereby declare Mat the contents of this consignment are fullntemalien ntl n Doak governmentalgovernmentalntal regulators.if export Shipment and I y and accufat tle crihed above +he proper shipping name.and are cim th packae Primary +3r '33 N <br /> marked and laheledlplacardad,and are in all respects in proper Condition fortransport according to applicable iaam the '� C <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cs sent. '34 < <br /> I certify lhalthe waste minimization statement idemifed in 4U CFR 262.27(a){if I am a large quantity genefatori or (if I a mall quantity generator)is true, Month Day Year y02 -33 Qj <br /> Signature _ :IG '.31 <br /> GeneretorslOMero�s PdntetllTyped Name , n <br /> .10 <br /> J 16.Inlemational Shipments ❑Export from U.&�'' port of enlryfexte _ rD <br /> p- ❑Import to U.S. Dale leaving U.S.: 133 n <br /> Z Transporter Signature(lor exports only)', 734 rrt <br /> fD <br /> W 17 Transporter Acknowldt <br /> egmenof Receipt of Matenals Month Day Year ?21 Q <br /> a Transporter 1 PrinledlTyped name Signatum - - r}4 O <br /> 5�+A1,J k 6lonth Day Year 3; <br /> z Tran 2 Print Typed Name Signature 1 rD <br /> a +� D <br /> = o <br /> 1 .Dlscrapancy <br /> 18a-Discrepancy Indicalion Space oual ❑Type ❑Residue Rejection <br /> Part al RejeC1 Far.Rejection t fD <br /> N <br /> rrt <br /> Manliest Reference Number: O <br /> 0 <br /> ll.$.EPAID Number O <br /> 18b.Alternate Facility for Generator) f7 <br /> !y <br /> J r-F <br /> VfD <br /> LL Fac1Bty's Phone. Month )Jay Year 1? <br /> Ln <br /> w 18c.Signatureo(WtemateFasTlyfro Generator) <br /> Ota <br /> a <br /> Z11 11 Q �] <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardo11 u 11 s waste Ireatment,disposal,and recycling systems} 4 <br /> to2. 9 (DD (0 O <br /> 1. <br /> O <br /> 1 <br /> t^Yeaf v - <br /> � <br /> _ <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba Month Day � <br /> v <br /> Signature rt = <br /> Pnnledlfyped Na <br /> rACILITYTO GENERATOR v o <br /> iR S e lions are obsolete. n Cirri <br /> rQ '* Cl) <br /> CD 00 <br /> n O <br /> - o v <br /> O G <br /> r9 - <br />