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Plea i so prit or type.ford de$1 ned foruse on o)lte(121pitch).typewriter.) Form Approved.OMB No,2050-0039
<br /> UNIFORM HAZARIDOUS jI.GonorsIorlDN,Umbq 2,Page I of 3.EMoroency Response Phone J1 4,Manifest Tracking Number
<br /> WASTE MANIFEST 00-468-1760 0
<br /> SKS
<br /> 1 0,52M`335
<br /> 5.Ganaralor's Name and MaillngAddress Gefianin?q,011A Arl ro-s-a(if different than malting address)
<br /> L:14 ',.17th St
<br /> Generators Phone: 9 1 G--4 44 25;'.,F!
<br /> 6,Transporter I Company Name U.S.EPA ID Number
<br /> MPFTY—��,A'-N
<br /> 7.Transporter 2 Company Name
<br /> U,S.EPA 10 Number
<br /> 8.Designated Facility Name and Site Address C', FAN HAKY.)IRS Rt IN Jf)3. L 1.c US.EPA ID Number
<br /> 1. 21 DEMIRYMIJBIA RQAD
<br /> N JOISP. cn
<br /> Pflcllitys Phone: C,A,D Vt b-cl 4 943, f
<br /> ge, 9b,U.S.DOTDascription(including Proper Ship Ing Name,Hazard Clam(b Number,
<br /> 10,Containers
<br /> M and Packing Group(If any)) P;� 111.,Total 12.Un 13,Waste Codes
<br /> No, TY Quantity WuV.:1
<br /> N1`X%1 RCRA HAN, MIX.' wflan... �ia-voq', &-'2
<br /> PETRO
<br /> DRO PROONS) N A
<br /> 2.
<br /> 5
<br /> 4,
<br /> o'
<br /> 114,
<br /> W.Special Handling Instructions and Additional Informatio I
<br /> Ta sTi 6677648,3 -;Lt
<br /> Y
<br /> P 4 HR
<br /> 1,nrN\1T-.r,(A AV
<br /> r4f-W Tyl ar,lrf4TNI 1 7 I-AA f) t31 12 vlapr4jr-YR 04Z wz:r
<br /> 15. GENEFZATOR'SIOFFEROR'S CERTIFICATION i I hoeby declare that the contents of th%*'signment are fully and accurately desiAbed above by ihege�vp—pinp name,ar'd are classifle6packaged,
<br /> marked and labef0plararded,and,are In all respects In proper r
<br /> ondillon for transport according to applicable International and national governmental regulations,If export shipment and I am tho:Primary
<br /> Exporter,I certify,that the contents of this consIgnmen conform to the terms of the attached EPAAcknoyAodgment of Consent.
<br /> I cattily that the waste minimization statement fontille I In 40 CFR 26227(a)(If I am a large quantly.generalor)or(b)(ifl am a small quantity generator)i§,Jrua,
<br /> p6neratoedOffero(s Printed/typed No," i --rign—alure t # Month .Day Year
<br /> 16,International Shipments
<br /> F-1 import to U.S, D Expert from U.S, Pon Of entrylexil:
<br /> Transporter sig,ature(for expoAs only): I
<br /> Date leaving U;$.:
<br /> 17,Transporter AcknoWedgment of Recelpt of Materials
<br /> LLJ
<br /> Transpo*rA Prin(odirryped Name Signature
<br /> Month Day
<br /> 0 a,
<br /> V jez-x- -.0. 'e-,
<br /> Signature "M61ith :ra 'Ye--3 t
<br /> Z Transporter 2 Pdntodfry#ed'NamfP'
<br /> <
<br /> 18.Discrepancy
<br /> 18a,Discrepancy Indication Space Residue
<br /> 0 Quanllly�
<br /> EITYP, Partial Rejection ❑Full Rejection
<br /> Manifest Reference Number.
<br /> 18b.Alternate Facility(or Generator),
<br /> U.S.EPA ID Numb7el,
<br /> Facility's Phone:
<br /> w180,Signature ofAllernale Facility(or Generator)
<br /> Month Day Year
<br /> 119.Hazardous Waste Report Management Method Gods(Li i.,codes forhaz:74tdlous waste treatment,disposal,and recycling systems)
<br /> 2.
<br /> I.
<br /> 4.
<br /> 20,Designated Facility Oymor or Operator,Codification fre elp.161howdou lnaferld,Ovorod by the manifest except as noted In Item lea,
<br /> Printedfryped Name Signature Kdl
<br /> Month Day Year
<br /> t ch
<br /> EPA Form 870C42(Rev.3-06) Previous editions are bso ete.
<br /> GENERATOR'S INITIAL COPY
<br />
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