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M <br /> 1 1 1 1 1 0 TI O 0 <br /> OOOOOO 2 -40 <br /> v' -0 <br /> �0 <br /> - - CD � 0 � (_0 �' <br /> v 4�-, N NOCfl (n 0K) <br /> O O O GJ —1 O O <br /> � NNOCfl � *k - 0 <br /> O (D000 N SCO D <br /> TI TI -n –n TIO CD <br /> v <br /> 0 r r r r <br /> mmmmmo �* <br /> = 00:�� � � <br /> 1111111111111111111111111111II11111 � � � Ili Ili <br /> N (0(C) <br /> Form Approved.OMB No.2050-0035 3 4�- <br /> Please print or tvpe.(Form designed for use on ehle(12-pitch)type-t.,) <br /> .ti UNIFORM HAZARDOUS 1GenerarorlD Number 2-Page I 3.Ema Resonse PMne 4.Manifest Tracking Number <br /> WASTE MANIFEST �^^� p 012120208 FLEI ---- =3Cr, <br /> 5.GenemtiaF Name and Mailing Address Gemeratpls Slla Atldrecs III diflerenl man mailing address) <br /> � � O�-. Z <br /> G7 (n m <br /> Generators Phone. U 5.EPA]D rvumber 0) <br /> 6. r nsp^ner t nmpamy Name j 0 <br /> 7.T2^spoder 2 Cmmpamv Name U S.EPA I (D Q <br /> U) O <br /> 8.Dealgrated FS.Ity Nameand Site Address US EPA IDNumher < (n <br /> C <br /> Cn <br /> Fatality's Phone. O 0 <br /> ga. 9b.Us DOT Des.nption II^chiding P--,Snpprmg Name.Nazam Class.ID Number. 10.Containers 11,Tp181 12'J'r 13.Waste Codes (n <br /> HAl and Pacrong Group litanYll No_ Type Quantity wt'ftl (D <br /> 1 <br /> a Q D <br /> o <br /> m <br /> c <br /> J <br /> (D <br /> 1a.3p—ll Nane;ny 1-1, 11,AdViia^a,In'prmai, <br /> O <br /> 7 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedare that the comlents of Ws cpnsigmmeot are A1fly and amuralel described above b the o <br /> marked argil label Y y pr per shipping name,aM are daevfea,packaged, <br /> adiplacaNed, <br /> andam in alf respells.n proper mndlopn Eor W nspon according Ip applicable international and national pvemmental r uladons.Re N N N O <br /> Exposer I cEsiiv toot the wntents pttnis consignment wnlwm m the terms of the attacneb EPA AcNnawledgmem of Consent. g � xPolt shipment and I am the Pranary <br /> 1-0 a191 V'R waste minimlration slalemem idenrfed 1190 CFR 262 27(al(if I am a large quanta i <br /> ty generator]or(bl(h am a small quanfry generator)Is true <br /> Gene,atoralDne Prin ypedNamE igna re - N N N o � <br /> a yY.F. <br /> 16 mtemalmnal s p—ti ���. _ 4�, 4�, 4�-- <br /> Z ❑Imgod Ic U5 ❑ErW from U.S. Pod of enbylaxil: O N n h <br /> Cn <br /> Tran e1 nature fq Ex d11 I_ ^ <br /> W 17 T-1Vnd2r Ack-,Aadg-1rt of Rec rpt p(tAatetials Oate leavin U.S.. <br /> Tmrgpprtw 1 ignadre m m m m <br /> C& C� <br /> sporNr2Printei•T:meo Name Is nature I _ N N N W <br /> C _ <br /> G'L" _ v¢ar <br /> � :E.D�suepanly � � C—Ti W <br /> ilea Denpar�y lmiar.,-.r saace ❑ W W W <br /> J Ddar,'.r. Type ❑Residue ❑ <br /> ❑Partial Relecbon FuN Re{acror <br /> I Bb.All r FaaiM fa C>er�xar( AtaMe51 Re[erence Number <br /> US EPA ID Number <br /> t` ra]M s Rtr�'E <br /> � 18c$g1aslR t#A1�nak Faryily;rr Grcl-avw� � � <br /> a W N <br /> � 4brtl Oay reB <br /> 15 klazardtas H';s Repot liaagc»rda kkaroo Groes a aces fx nazar�,s wave mall— <br /> P dnwsai_and ra TC N sr5le:ns <br /> i <br /> ?G Des.gr'ateo Faday <br /> 0r1e,•o apaa�r Cta ,or-w d:y-rtm5us matmas <br /> .ama aY u, ere armaast a <br /> Rrwaea'{:c Name aceat as rp�s m€1¢rn Aga <br /> Sigrtabae <br /> cca ;T�v 3-051 Pyenae &�aD;oiep '•L" _a, rex n <br /> C N <br /> GENERATOR'S IiiIT7AL CW0Y D O <br /> (D <br /> Cn O <br /> CID 01n <br /> O (vW <br /> � v <br /> M (D 00 <br /> N W <br />