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N <br /> CY) <br /> 00 <br /> I\ <br /> Cl) <br /> Ef) O <br /> CD <br /> ryCL <br /> it <br /> 0 � <br /> 6 <br /> O sa w+IPr <br /> ( F'laeaa A,v '.fin ADprrr90 JIJE':'i<GY�.(/;xa <br /> r <br /> °C yWONeaG,RMAOe <br /> 6 MpSA2910=5 KS <br /> _,MiMr9b� rq Annranr �raair AAanM 1 AP rre4Q arh:rmei <br /> Conttathh�RrO Or DtM Rotor TeM <br /> 7YOCMTQd r •1 Wilily '�'te R <br /> CA 9't?.13-96% <br /> „.e.elan wren. 2S9-346-W.NiQ <br /> SYSTEMS INC GEP-,C- <br /> us <br /> PAc. 7xaONBBb12B5 <br /> nxwrmrw. u s.EPA c0 NUMmar <br /> CLEAN HA R8 ENVIRONMENTAL SVf-. INC, Mgi;9393r2238 <br /> e r N.rad CLEAN HARBORS ENVIRCMlkIFNTAL Sf_RV10E8, IN us FPA Dry <br /> 2247 S HISHWAY 71 <br /> KIMBALL , NE 69143 <br /> 3iS-235-4a 12 NF D9H 172351.3 <br /> � wax,a <br /> w sb V S DOT DpuyMu,fa h4V Pwe Shi Na".Ha 0 CW ID NumM, to Gill®nes11 T— 12 Urn <br /> HM ane P*ckmp GW cagy N 7 rNasb vidaa <br /> No Type Grandry VI!Non <br /> X t 11NI263, WASTE PAINT, 3, PC 1 f I DM P F. <br /> dS l: <br /> i <br /> w <br /> u <br /> 5rwur HaMPlrg msevdNons amadarrw,al rnmm:an„: ,::i i:r:•. ”:yN7304© ,.:�I �, _.s. <br /> r rF.RMF I?Hf <br /> v_RGtNCY8Ef00-468-1764 CH/SK/TFI C ntract retained raiDr ronfere <br /> an initial transporter to add r.r substitute additiara, iters an none <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the cements of this consignment are fully and accurate•; �,e by the proper stuppey name. <br /> marked and I.Wedlplacarded,and arem all respects in proper condition for transport according to applicable inlemaoonai and national govemmental regulations If export shipment and I am the Primary <br /> Exposer,I cemty that tyre contents of this consignment conform to the lens of the attached EPA Acknowledgment of Consent <br /> I ceNhfy,that the waste nummization stalemem,dennr:=d In 40 CFR 262.27(ai(if I am a large quantity generator)or(b(if lamas^'au ..a^ray'generatgrt is . <br /> GiveralofsrOSeM's Pnn(Wyped Name I Signature r taond; Day Year <br /> ematlonal Snlpments ~. <br /> ❑ImpM loU= ❑Epen)rem UP. '.-.-- <br /> ? Transpcnersignaturelfoexportsonly) _117 TraneWw AanmLdgmentof Receiplof&lalerars <br /> w <br /> w TranspnNAr 1 Pnnled'Typed Name <br /> Sgnabr- Month D.y <br /> aI ice: I •,, <br /> Z Transporter 2Typed Name <br /> Signal— Aborti <br /> rr <br /> r <br /> ♦ 18 Drv_'epanry — - <br /> I 7fia. IMialron$Dace <br /> ❑Ownln, ❑Residue ❑P..ii ReFLO.-.-.. ❑ <br /> r Re(ac4on <br /> 18b A yrrate Faality for Generamr, Manifest Reference Number <br /> U.S EPA ID N,7 <br /> -- <br /> L) <br /> LL Facecty;Phone. <br /> w '.6C Sl r.alureofAlemate Facdlly(or Gener)tor) <br /> a !corn Day veer <br /> Z <br /> 00 <br /> w 19 Hazardous Waste Repos Management Method Codes it.,codes for hazardous waste treatmentdisposal.and recycling systems) <br /> N _ In 2 3 <br /> Ln O <br /> N E 20.Desgnata;;Fauldy Owner or Operator CenNGcatron of receipt of tleZardous malenals covered by the manifest excepl as noted In Item 16a <br /> O 1 PrmladfTyped Name Sgnature _ . <br /> cA EP F �.1Z�v 7;W--editions are obsolete. <br /> O �) sbe8yl " <br /> O GENERATOR'S INITIAL COPY <br /> C O U <br /> O <br /> .6 T ct3 <br /> O > <br /> Q- <br /> C/) <br /> ccts No Q _ <br /> W <br /> L) Q TCp <br /> HQCIO <br /> E O o <br /> o � � p <br /> OCrcili <br /> In H <br />