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r r r r <br /> oo00 � = -40 <br /> N N N CD 0 v <br /> 7 -P -P -P co O <br /> v W 0 I M = 0 N � <br /> Cn Cn W O O_ <br /> O 6) a0dOM N07 <br /> M. CO Ul I O(Q CDD <br /> TI TI TI TI v <br /> o r r r r3 � <br /> M M M M W <br /> M w W <br /> _ m cn <br /> 4 N N W c O <br /> Ln W W <br /> _ O O N <br /> Please prrnl nr type(Fano deal for use on ellte(t2-ptMhl lypewrilar( ^ <br /> 111111IIIIIIII! � � � � C) N <br /> UNIFORM HA2AROOU3 i Gerrernlm l9 Number 2 P c-^"A,rgr7riV' f.F�NC. p!)b•'fi `; U/ ^ ^ u' I�T�I <br /> ap 1 W 3 Eeer0—Rtryprne PII01! 1 YrnNM TracYiny Nwnes ^' �l' U' J N <br /> WASTE MANIFEST Q11387Q79 FLE `' `' `I `I <br /> „er,eral�,reName,nd aiaagnddmea v J W CD <br /> Genravxs Addr.ae r4 asrrrq rte. O W W O <br /> W� CD <br /> Genemrye PMne. O . <br /> mnsponerf pmaany ame � <br /> V5 EPAA%-dw cn <br /> 7 iran5ppner2 Company Name O <br /> on.= G <br /> 'J S EPA ID Manes � <br /> DCII anesgnaled FeGaty Nameana Sile AOdress 0 <br /> aaia <br /> u sEPA ID Mone. O 7 <br /> aro <br /> or <br /> Fa lily's Phone- 0 <br /> ROu ga 91,.US.DOT Desm Iron (Dy <br /> ➢ Imeluding Proper Shipping Name.Hararo Class,ID Number, <br /> nAa and Paling Gmup is anyll f0 Ca�ramers - �� <br /> I t No TYR �S�a•,.r� V., - - <br /> \ui CD <br /> Q <br /> z 2. O <br /> C7 � <br /> 4 O <br /> 3 <br /> 14.Special Handling fnslmcrions antlAtldi[ional Information ' CD <br /> Q <br /> r r r r (n <br /> O O O O <br /> O O <br /> t5. GfNERa dbe10FFEROR'S CERTIFICATIONI IheredY tleclare that the contents of this oansgnmenlare lolly antl accurately described abpveb 00 00 <br /> marked and labeled/placartled,and are in all respects in proper condi0on for Iranspon according to applicable international and national O W O <br /> Exporter, ceroly that the contents pt This consignment Canfolrtr to the terms of the attached EPAAcknowledgmenl of Consent. y Probe shrpq'r9 arm aro ctassdaxf agEaoad 00 CIl 00 W <br /> I cenihj Ilial the waste minimization statement itlenlfied in 40 CFR 2fi227(a)lit1 am a la 4ovemmental regulahons,ff d pdt shyxmanl ane I art ere Ps.ay O W <br /> Generaro sl nerofs Pnnfed yped ame rge quanfiry generator 00 00 O N <br /> rgna ore or(b)lif am a small quanpry generator Is We Lri 4�6 ---A ---A <br /> CO CO CO O n <br /> 76.Inlemational5hipments -Tl -Tl -Tl - —_ <br /> z trans over si nature for ex ns om Impar to us. r r r r`G <br /> ❑Expon rmm us. Pun ar entrylexm fll fll fll fll <br /> W 77.TransponerAgmpwletlgmenl of Receipt of Malenals Date leavin U.5�-'------ _ _ <br /> Transposer 7 PnntadRYPetl (� (� Q0 <br /> D <br /> rgnature � N N QO <br /> Z Tran5poser2Pnr4ed(ryped Name I On y OF) 1 CO <br /> ignature 40 <br /> 79.Discrepancy Abnth � <br /> 18a Oiscmpancy ,Indira tion Space <br /> ❑Quanbly ^ <br /> ❑Type ❑Residue � � � U' <br /> ❑partial Retedroo J <br /> 16b.Altemafe Facility tar Generator) <br /> Manifest Reference Number v W <br /> a O <br /> aL Facrlll's Phone. U.S.EPA ID Number <br /> w fBc,SigaatarenrAltemate Facllily(gr Generator) <br /> Q <br /> 2 <br /> I7R.Hazardous Wasle Repan Management Medgd Gotles(i.e„codes for hazardous waste treatment,lis <br /> and <br /> O t Pal \'e3� <br /> 2. Waal, recycling systems) <br /> 3 <br /> 2e.Designaaed Facility Owner w Operalor.Cenihcanon o1 receipt of hazartlaus materials covered by the manliest except as noted in Item 18a 4 n X <br /> PnnledRypetl Name C N <br /> n <br /> Signature D O <br /> EPA Form 8100-pp(Rey,3-05)Previous etlitions are obsolete. � <br /> Month O <br /> Dav 1"ear <br /> CD <br /> CD GENERATOR'S INITIAL COPY I N <br /> - <br /> rQ <br /> 1 O <br /> Cil <br /> O 1 �y v <br /> (D W <br /> N W <br /> Cl) (r <br />