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L)t is �.K 91-3.11 <br /> Please nnl or e.(Form designed for use on elit (112-pitch)typewriter.) 2 e*"x"` <br /> P lYP 9 B{ P )tYP ) � 'C,% Form Approved.OMB Nar20500039 <br /> UNIFORM HAZARDOUS i tier 2: age i of 3, erg'nc_ n s Phone •M If tr]7a kin N76661 <br /> 'y �ii 1i� i�C . } 3t�; 1 t I tl .,.r�Cyte".I:J(x( S4 <br /> Generator D um <br /> WASTE MANIFEST <br /> 8,Generators Name and Malting Address Generators SileAddiess(if(fifferentthen mailing address) <br /> CiSir.,c: Air" ySLFIitz" ji1L.', <br /> 1 4 i-<'t Ii Lit' <br /> Gene aftor's Phone:r {J 1 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 91AFT.FY•••[4(..EENw�l� i L plus 1 MC, 'I'XR@001MI22 QIQ <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> i <br /> S.Designated facility Name and SileAddress U.S.EPA ID'Number <br /> t'IAIRBORG B.AN 3030-.', t_h.t, <br /> .t�ti�,:i. k��fi�tYf�f3r�sF) �t)t�S1 <br /> ( <br /> SRI 11031F, 4 t t 9513:3 <br /> Facilit's Phone: <br /> {�;}�it"•}.,r/'t'j ?ft it It;SCAN,'.?s�'Y:7 <br /> ' 43_ <br /> ga, 9b.U.S.DOT Description(including ProperShipplir g Name,Hazard Class,ID Number, i0.Containers 11•Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WL/vol. <br /> i 14iitif, hl )!1 I;i`,1�t1 {!F�!r41 t I�IJ i ;lf YE gill) E1 (sy UPI P 1"3 <br /> r t?Z tJs P..!ROL.r_I jM I HYDROCARBONS)S), 'm n . <br /> Z 2, J <br /> W <br /> 0 <br /> 3. <br /> 4. <br /> I 1 <br /> 14.Special Handling Instructions and Additional Information <br /> `+C5 D J x;1:337 3 Ewl;»x <br /> 84 HR F-14 EROENr;`r' 3:� �? 1'I li S '7 t (;),K I TF 1:) <br /> ry'+, C' llrt 1 u 1t: 1 t t?• t G :2i 3i 1t !L w .y <br /> 15; GENERATbR'S dFFEROR'$ ERTIF10A ION:i'er by dicta hat a wntenis of s constgninent Ora yen acixtra e(ydescdbed des"6y Ins gropersipping name,and era classified,pso8 ged" <br /> marked and labeledfplacarded,and arean all respacts 1 proper condition for transport according to applicable lntemagoaef and nolionef governmental regulallona.It export shipment and I am the fidmery <br /> Exporter,I certify that the contents of this constgnmant Wntorm to the terms of the site chad EPAAoknowledgment of Consent: <br /> I certify that the waste minkmizaltonalatement IdonBg in 40 CFR 262.27(a)(if I am a large quantitygonefator)or(b)(ff i am a small iluantity,gonerator)is taro. <br /> efieratoeslOfleroes PrintedfTyped Name jj Signal e: r Month { Day +year <br /> .j 16.international Shipments <br /> Elt <br /> Import to U.S. ❑Export from U.S.) Port of anirylex: <br /> Transporter signature(for exports only): + DataTaaving U S <br /> I w 17.TranspoderAdnowIDdgment of Receipt of Materiels <br /> 4Transpoi'PrintedlTyped Name Signature: ; Month Day Yeard. r,. , /'o F PtKtod7Typ0 N `e / Signal ro" Moritli 0691-41f."% <br /> i <br /> 18,Discrepancy <br /> i <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity', ❑'type: ❑Residue �Partla!Relecdon ❑FVII Rejecgon� <br /> Manifest Reference Number. <br /> 18b•Alternate Facility(or Generator) US.EPA Number <br /> a <br /> t� <br /> w Facility's Phone: <br /> Uj <br /> 18c.Signature ofAlternale Facill (orGonerelor) Month Day Year <br /> i <br /> 19.Hazardous Waste Report Management Method Cod s(IA,codes for hazardous waste treatment,dloposal,and ragollng systems) <br /> i. 2, 3. 4• <br /> 20,Designated Facility Owner or Operator Celtlflcallon Of recoipt of hazardous.materials oovered by the manilost except as acted In Item Up <br /> P pe Normo gra ure on ay ear <br /> n odffy <br /> EPA Form$70022 Rev,3,05 Previous editions are r^� GENERATORS INITIAL <br /> C <br /> { ) oboe Ste, pPY <br />