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j <br /> Form Approved:OMB No,2050,0039 <br /> Please print or type.(Form designed for use on eine;(12• itch)typevrriter) 2 Peg tot 3.Emaigency Response Phana 4,Manifest Tradking Number <br /> i.Gunuralor ID Number 006169393 SKS <br /> UNIFORM HAZARDOUS i�.t ii 'Zt`�'t"1 y+4, �>st`� ,;�, �"f�A+a� =tLr`8 ��f� s <br /> WASTE MANIFEST 4 Generator'sSileAddross(iCtlifterentgtanmaliin ad re s) <br /> GeilGf"i'��'G Name and Mailing Addre s <br /> ts{ ':i) t i •jai 1 gar, ,r;%r U;S;EPAIDNumber <br /> Generator's Phone ^7 1 } <br /> 6.Transporter i Company Neq <br /> F y ;1 r 5(w7 ;3iI u U,S.EPAID Numher <br /> !< E!.,.,t <br /> j r,. r �l� <br /> 7.Transporter 2 Company Name 3`93} ,firtrO <br /> ITAL U.5:EPAID-Number <br /> B.Oosignated Facility Name and site AddressWl� gy� <br /> r'l AP, 7 y <br /> Facility's Phone: 10.Containers ti,Total 12,Unit Q.Waste Codes <br /> TS',OGT Desedpiton(including Proper Ship ng;Name,tiazafd Class,10 NumbeY Type quantity WI,Noi: <br /> o.acking Group(if any)) HkZL�";1� `~, , r l '' +_i <br /> 0 <br /> 4 e_.. <br /> t4.Special Handling Instructions and rldditionel Iniorma on r 4 r%!60:s:y'F <br /> } i S",Ttq <br /> Jai j <br /> i F�C�� dFr�....A iJ r'•� ±� t. 1 r. 1a ..» <br /> �4 HyR cjlf +1 Cis~`l � <br /> Icabie international and national governmental regulations.If export shipment and <br /> am the Primary <br /> 119: GENERAL R'SIO PNRt7 rS j;TIPiCATI N: I <br /> he 13 del a ihalthe"c nienls of this`conslgnm ntafo' i and lately desc ibG�'a6oveby thti prop rship inti name,and are ciassi8etl,package <br /> marked and labaledlpiaoard c�ndare in 8111{aspects in{roper condition for transport according to eppl aneralnr is.We.. <br /> Exporter,I cerci that i e c.1. 1 s of This consign en conform to the terms of the edached EPAAcknowiedgment of Consent, Month Oay Ysar <br /> ifyditat ih waste: inlmization as <br /> menlide f 81 nth 40 CFR 262.27(a)`(it Iam'a targe quantity SrAger lues or(b){(tlam a smallquangly g ) s" fry . <br /> ensr r Groes Printed yped Name 1 1, l <br /> 16,inlernatio�r Shipments Impart to U. . ❑E' from US, Port of Gnlrylexil: <br /> �- vafe Iaytng u.: <br /> 7Z Transporter signature(for experts only): . t <br /> Month Day Year <br /> w 17.TransporterAcknowliadgmentof Rece tit of Matedais <br /> Signs twe'� <br /> Transpo PdfTyp <br /> nteded Nsl- <br /> 11, <br /> ' Month ay j Year <br /> Signature ,moi <br /> x 7ransp do edri e Na <br /> 18.0 scrapancy ❑partial Rejection Ful Rejection <br /> 188,Dlscrepsnoy Indlca11on Space Quinti <br /> ❑Type <br /> 'PRO. <br /> f Manifest Reference Number: U:S,EPA iDNumber <br /> tab.Alternate Facility(or Generator) <br /> v I - •• --- Month Day <br /> Year <br /> ud Facility Phone; <br /> w 18c.signature of ARM=Facility(or Gunaratet)I <br /> d <br /> 19.Hazardous Waste Repa((Menagenle+itMott iotl_C dss{Lo„codes fortiazardous was18.1re�lnront,dispsal,and recycling systems) 4 <br /> 0 1' <br /> ont6 DR Yeah <br /> 20.Designated Faclli Owner o pdraion CaAificatl n of re t of hazardous materials covered Uy1he msi9tnet ex t as ndgd4n It 16a <br /> Pflnlodff pad ame <br /> Ci'CSIGNATED FACILITY TO GEN1=RAT Fi <br /> 6 ob <br /> EPA Form 8700.22(Rev-3.05) Previ' us editions a solgt ,r <br />