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Please pnntdrlype: (IF <br /> ormdgsigneddfortoakon e11te,(:12pitch) typewriter) I Form Approged. I BNo. 2050-0039 <br /> UNIFORM HAZARDOUS 1;Generator lD Number - 2.11 bf. �3 Emerges y Response Phone 4 Man! tTrack ngNumb r <br /> n <br /> g_ <br /> IF <br /> WASTE hANIFEST i 11}art + t ' tid ,..: : �.' - dr , "9Ea .� :JJ <br /> S. Generators Name and Mailing AddI IF <br /> ress - ' -I IF IF General Site Address{ifgigailthah mailiogadtlress) ' > . <br /> IF 1 41 <br /> ffld . <br /> IFGenerators Phone:%4 .:3 ',. 5 : -3 td O <br /> .6.Transpolt t] CgrnpanI Nam C iiip tap- tR f�`t�t . phi - U.S. EPA <br /> q*IDR. Number <br /> . , F"�i Ta 4a)t, irv�� SfVLat�v �k"rya ti+.�. r. �t ){ t _ � .nS <br /> 7: Tranaiorter2:Cpmpany Name ,,. . ': . , _ : , . U.S. EPA IO Number . . ' �. <br /> B. Designated Facility Name and Site Address IUS.EPAIDNumber <br /> I IF <br /> b .+ filPic '- f--. c if tr [ ttii ( S In i ? k, <br /> IF <br /> 14: � : r L9 h � v . r4.. <br /> .t <br /> IF IF I <br /> Facility's Phone. ;�tJ d > - �13J IF IF -- <br /> IF <br /> ga 9b U.S.007D cdptiort(inpludi I Proper Shipping Name,Razard Class ID Number, IF. 10: G ntalneis 11 Total, 12 dri 13 .Waste Codes <br /> ` HM and Packing GroI IFup (d any)) No, Typo " Quaagty ; . WWI I - <br /> 1 . <br /> ,e tg �y €•.r F <br /> 5' IF <br /> Cf) � 3^iMft ) !IF 115 Pf' ; .ryt 1 ' (17I IF . . .. aF 8 - I <br /> IF 6 <br /> IF if <br /> w2 <br /> . . . . . _ _ gg <br /> IF <br /> € 1 <br /> 3 % vIF <br /> , � <br /> IF <br /> ¢ - <br /> IF IF <br /> .14SpemaHiandling.lnstIF <br /> mctions and Additional lnformallen <br /> s 41FC rY §1 a Ct# Q <br /> 4 �` k yFlet`'r �*��.; �"C t�' ak1?#-0 s'',tFi;FiFF ' i r``; 'T sits o f >> f,d '':V R 1 '>t, Jill "f . L 9 1 s+x �^�"n <br /> r ..f ,:nv_ t 3 `(�+ P N k - ..�' ✓ ate. , i i.-c c ,r+ " a - .O ' <br /> 15, GENERATOff'SfOFFEROff'SCERTIFICATION: thereby deciarelhat the contents of1pls ounsIgnment are fully, and accurately described aboire by the propersh�pingname declare classified, packaged,' <br /> marked apd label dlplar;m F -FIed,andere igalltaspects in pr per cdntlltion for trarl according to applicable mtemallonal and nati nal goviannim al regulations 1(expod shipment and l amthe PdniI . ary <br /> Expoder,I corgyri ifthe'dontents ofthlgconsighmenl conform to we terms cities aitaQh d. EPAAckhowiedgm nrofConsent. " <br /> tceddyihaUheWasie mization slatemedlidendfied in 40 CFR 262.27(a) (If-i am a large quangty geoeiatoo}or (b) (ifl aida sma ritiar titypen color) is me: ' <br /> Genemt rsfOfferor's'Pdntedlirypod arg6 ++ Signature ' � -p Month pay Y}eaarrr.� i <br /> ` l d A a-�"* rte" ijd ." ,rt=", d} ' <br /> --r 16, Int maSonal Shipments I� ;: � . ' w. ' " <br /> r ❑lmpod is U.S . . ❑ Expprtirom U.S, Pod ofeniry/e8i[ <br /> Tpanspod r ,lgnatum ((orexpodsohy) Date leaving U.S.:I IF , ' <br /> W. 17, 4anspodergokndwjedgment of R@ielpl of Maledals .: ., , . <br /> K Tmnspod l tedayped Nama Signature - Mo_0th ' Day Year l <br /> 45 e <br /> I IF a .Transpoder iFirmTo'tl7lyped Name ' _ . - Signature f. v s.+� "F F+ M nth Day Year " ) <br /> �. <br /> 18a Discrepancy Indication Space ❑ Opankry+1 IF I I IF❑Type _ ❑ Residue " ❑ ParBal Rejection LJ Full Reliant +� <br /> I IF _I IF <br /> Manifest Reference Number: <br /> 18b Allmate F.adility (or Generator) . - I U.S. EPA ID Number <br /> - y. . . - - <br /> f:a - _ - <br /> - rat. Facilitys Rhone: IF <br /> W 1BCSignatue ofArehate FaGhty (or Gandmtdr) Month pay Year ' <br /> - . . - <br /> y .10. Hazardous Wasle.Rep ri MaOagement Method Codes (i.e., odes for hazardous wastatmaki disposal,:and recycling systems) ' " :x t• . . <br /> G .1' S 2 3, 4. i <br /> �. 20. Roosted Facdtty Owneror Opse tar Certificatin of m el t of haze d_ous matenals covered by the manifest eec'eptas noted in Item 18a <br /> Pdnted/fypedNae d Signature .(„F ?f,., j Mont{hp Day YearF ? 3 <br /> �n,. ""�l �d � r""t' f � <br /> E .ForMR70022 (Rai 31Pregloosedltionsa[0ighgolete � n., �V MsirmmmPAGILITY'sC®pV ' I <br /> - _ . <br /> > :. - . . <br /> I I : IF <br />