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M CIO -Uop <br /> v m = VO <br /> N <br /> 7 -0 v <br /> v m O N G1 <br /> TI <. CD (D <br /> O7 <br /> v <br /> O O — <br /> Z7 3 Co <br /> M i <br /> Ci w <br /> Pbpae pant or 1 Form Me rred for uaa un x,111e 112 loll I � V <br /> UNIFORM HAZARDOUS 1"—'tar ID Y alba 7 Ppe t ai 7 EmarpslCy RaaV+e Prue 4- araaq ' N) <br /> WASTEMANIFEOT 011434269 FLE N <br /> ,annram ai,nina,r no .aa a W A"—11 rVire %r-&',aaYear N <br /> M <br /> ,nlwrewfs Phone � <br /> r, nr mNny emn U$Eli IQ%ji <br /> Iranxparler2 �aey Name us EPd DNaarw ,,^^ <br /> V/ <br /> .0 a I arrai On. r— U S EPA ID 4-tarr, O <br /> 111 C7 <br /> ax I O <br /> 1'arsa's PhD ry. 7) <br /> Ha ah-U 5 DOT Dsrnpapn irwi Proper Shipping Ha ne.Hazard Gaas.ID Number, I9 Cnnuvrgrb <br /> mRM and Pecking Gmup id anY11 Na Type t yh, 17 Nrs Gass <br /> D <br /> � 1 <br /> W <br /> n <br /> 14. pecial Handling Instructionsand Addlional hformi <br /> 15. GENERATOR'SYOFFEROR'S CERTrFfCATION:I hereby declare that the Conrenle of this consignment are fully and accurately described above by the proper shippingname,and are aassiii Pat caged <br /> marked and Iaheledrplawrded,and are in all respells in proper condifan for transport amording to applicable international and national governmental regulations.If export shipment and I am are Wlnary, <br /> Exporter, cedlfy that pileconfente of i consignment conformto the leans of the attached EPAAcknowledgmenl of Consent. <br /> I tarsi that thewaste minimizalen statement Idenaeed in 40 CFR 262.27{a)cif I am a large quantity generator)or ib)lit I am a small quigenemtor)rs We <br /> arierat me <br /> not y ame gna ure <br /> ay ea- <br /> 16 Irdematipnal Shipmenra <br /> i ❑Import to ti S ❑Export from U_S. Pod of enirylexif <br /> Trans drier sl nature fore X da <br /> dC t7 TmnsporterAcknnwfeogmenlof Receiplor Maleriale Date leavrn U.S.'. <br /> W <br /> Transporter t ni.yped ame <br /> one ure <br /> a On ay ear <br /> z Trensporter 2 PrinledlTypetl Name <br /> ¢ ignature <br /> F DothDay Year 1 <br /> Ti6 Discrepancy <br /> I 1 188.Dlacrepanty Intllrabon Spate ❑Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Full Refection <br /> lab.Alternate Faoibty(or Generator) Mani(esl Reference Number <br /> "J <br /> U U.S.EPA ID Number <br /> Q <br /> Fedlit a Phone: <br /> in <br /> ISC Signature of Allemafe Facility lar Generatoq <br /> Q <br /> y <br /> Month Day Yeat 1G Hazardous Waste ReportManegemenl Method Code6 li.e.,codes for hazardous waste treatment,disposal,and recycling system5l, <br /> d t <br /> 2. <br /> 3 <br /> a C7 � <br /> 20 Oea+gnaled Fsoil OWOaf or Operalor Certdication of receipt of hazardous materiels covered by the mamfest except as noted in Item 16a C N <br /> Pdried yped Name —0 0O <br /> gnalure D 0 <br /> EPA Form 8700.22{Rev.3.05j� Previous....dunns are Obsolete Month Day YearCo <br /> 2 � <br /> v v <br /> N <br /> CD GENERATOR'SINITIAL CpPY � <br /> O <br /> Q0 01 <br /> W <br /> O rn v <br /> (D 00 <br /> N w <br /> W LrI <br />