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<br /> Fnntt,Approve(i.OMB No.2090,0039
<br /> Please prir.�Dr type.((form designed for use on elite){12•)Itch)typewitler) }r- 2 P�7Q o � �� Y e Psg`�{lp j 4,,�anifest.Trac�k"i�ng Nu�m'�ber t
<br /> UNIFORM HAZARDOUS
<br /> 1.Generator IO Number )`"G. '• 4 c:1--t l.�e� r'� d• t„!t') el
<br /> WASTE MANIFEST Gerieratbrs Site Atldrass{if different than mailing address}
<br /> 5.Generators Name and Mailing Address 1
<br /> Mir,Y :'1`�l t t�s 1.14
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<br /> r Generators Phone: "1.C+ }"}Ȥ t_ r U.S:EPAID Number
<br /> �g p��^y,o,V�q�r�an.Ne�}e � i i�it'r3lrtYre:!� ri-r
<br /> 6,TJfaS Q �rl f `YtI .£it :' w{Ct•�sit, t It.n
<br /> U.S,EPAiD Number
<br /> TT sporlo 2 Company NameIf�(;'I�a•+`7 a
<br /> t:( Y(+i !� �? �!I� 'a" 1�lt1IrCSi`14t1y Ii{! U;S.EPAIDNumber
<br /> 8,Designated Facility Name and Site AddressKROHN ROAD
<br /> 'Lrl7 -15 1 uwi
<br /> Facility's Phone: 10.Containers 1f.T9tat 12.Unit 13,Waste Codes
<br /> ga gb.U;S.OOT Oescdptfon(inducting Pro'er Shipping Nama,Hazard Class,ID Number, No Type quantity Wt.Nol.
<br /> pp v
<br /> HM and Packing Gro cn'I'ny)) 1�N1 P
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<br /> q,Special Handling Instructions andAdditianai Inform lion T �T7:,a J
<br /> I:.tn�.':i�iIIEN# Y w"k-'�3r [tY rw�.. ( `r{� I r' ,Ifi•i ,- +HK 7�a a� va ,' ,. ! 2�
<br /> Ali i' I f, ":iL"~F'NT..;�;�R' 1�Y t Ew f �t t)�I Il i I GFF."•.#'�s r
<br /> _L kidp name,arxf are classi8edr packaged,
<br /> 15, I'll TOR'SfOKF
<br /> ENT
<br /> CERTIFICATION: I hereby declare ihaf the contents of this consignment are fully and accDratelydescribad above by Ihe.proper shi ping
<br /> marked and labeledlpiacardod,:and arelnraAlnsesn is In proper to O condition
<br /> f s of the ort,aattaccedrEPA10 Acknppwiable in t of Consternationat and
<br /> nationakgovemmentafregulallons,If export
<br /> shipmenland I am tho Pnmary
<br /> Exporter,I cerlifythat the contents of INS 9 Month Day Year
<br /> I car6ty that waste mhimlzation stetemertt ie lifted In dO GPR 262:27(a);(if l am a terga quanply 8�gnature cr{b)(iJl em a sine,quanlity genes tor)1s true: Month
<br /> tJ.ry
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<br /> net tr'slOHeforsPrinledlTyperName
<br /> ..y' t _ 1"r
<br /> ` t •�`�.:�� �j 5�'` Part of e�f fexd +
<br /> 16.international SNpmen imd to U ❑Export hom US. l ry.
<br /> pate leaving.U.5.:
<br /> a Transporter sig alum(for exports only):
<br /> Month Dayl, Year
<br /> LU 17.Transporter Acknowledgment ohReceipfof Material Signal re f
<br /> Trans poilt vi print Name
<br /> {�,,. >� sr' ,. y;,a,. ''�• � Men 11 Do, -Year
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<br /> a SI
<br /> gnatura
<br /> 4 Tratispo, r Pnnte pdd Name (�I
<br /> 18.Discrepancy ❑partial RejecQon ❑Fuli Rejection
<br /> 180.Discrepancy Indication Space Quanti y
<br /> ElType Rasidue
<br /> ❑
<br /> Manifest Reference Number. U,S,EPAID Number
<br /> 18b:Alternate Facility{or Generator)
<br /> J
<br /> v Month Day Year
<br /> `4 uFacility's Phone: '
<br /> 18c•Signature ofAite note Facility(orGanerator)
<br /> 10.Hazardous.Wasie Report Management Melth odor(i.e.,codes for hazer ous wastelreatment,disposal,and recycling systems) 4
<br /> w2'
<br /> a 1,
<br /> ! 1
<br /> Mgnifi Y. Year
<br /> 2D.Designated Facility Owneror Operator:Ce�ii6ca tort gfYaceipfof haz rdous materiels coveted by rho maSigfnascept as Acted In ltem/l8a
<br /> P(InledlTypa
<br /> f;,,,; 1,�rrwt, f.`:;t..�i�. �-�� ""� ,..• DESIGNATED EACILIT`l1'0 Gf; frRATOR
<br /> ��rn ,,n nr+ Pmvinn¢adffl0ne re Obsolete:
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