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M W -U00 <br /> (D x ;' ° <br /> -0 � 0) <br /> - CD <br /> TI - -._ CD <br /> o ° � (9m <br /> +rI o <br /> O T a rC �rMEr �ss�n ha '>re�, 00�7 �3p167c F _ <br /> M 3g0y4F J°tlor Tr t F; N' X64 ��E 3 rD <br /> t <br /> 9 E. fly <br /> rye Maht��i, �Oepo ae CA A." Del lMr lr*r012169 W <br /> �zcmrte,r cv a 9536-!,Mi 7.;A'j r. <br /> c1 3 <br /> ��� r•+�re SOperalf„ Mont <br /> frl <br /> 5o rut,nn� Int <br /> .Ma 1 tai o <br /> `15t Ce r, v to <br /> i?e�aoriry•9bp�. 'r 755'Sc 7� CD <br /> us DoTA F'er �u <br /> rtleVwlE•nrt' Ea_t � v <br /> MI- rtUN1 cru r�"°Powsh 69�g D <br /> 950 waste Ae asa ^svema,aao,Pn`me,. EH NIcS t IvconkmenTVP. 11.Tew 'Ru„ '3wwoc4ru (D <br /> CF 00014 P 331 D9@ l <br /> QJ <br /> - 7 <br /> (D <br /> 4 D <br /> 14'Si>eG'al'Yar+dling instructions and Ad didonarinrromap� t <br /> r 10iddM?,tAer-�sn15r i <br /> f5. <br /> GENERAT0R'810FF <br /> RTIF! <br /> Expose marked and late—placarded CE CATION:fhereb d <br /> t rfr t V that the contenand are in alt respects In Y eciare that the contents o(Ihis consignment are full and acvuratel <br /> on <br /> ator'fy that the waste's'co to is of thrs co^sr9nment'n""'Per Con&,,,for transport according ro applicable in Y desco6ed above 1) the rove f(ero�s P on statement rM to the terms of thea Eemational and national governmental vrshippmg�namePand are dawfied,pKKag®d <br /> dnted/T kienGfied in 40 CFR 262 Z7 a itached EPAAcknowledgmenl of Consent. regulaUvns.Ir ex rt shi ment and un the <br /> Y Name (}(r(I am a lar <br /> ge quantry generator)or(b))rf am a small uanli Prxnary <br /> r6, ntemation 1' rv� <br /> al Shipments rgna q y9eneraEor)is true_ <br /> 'r nsrtersr nature for ax Dmport to U.S. �` 1111t: <br /> .TranSportarAcknowi ortsoni I. Ej <br /> edgment of Export from U. c 3 <br /> �sporter 1 Printed/r Receipt of Malenals Portentry(exi- <br /> YpedName Daielele in U .�'------- <br /> Poder 2 Pdnt19nature <br /> e yped Name <br /> do By ear <br /> rePancy ��rC gnalure I i <br /> .repancylndicatlon Space Ej ati ea' <br /> Quantity <br /> ❑Type <br /> ❑Resitlue <br /> rte Facility(or Generator) �Partial Rejection <br /> ❑Full RejecGpn <br /> Manifest Reference Number. <br /> ne: U S.EPA ID Number <br /> 'c"Jteraate Facility(or Generator) <br /> Haste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Month Day Year <br /> 4 z. <br /> 3. <br /> ;Airy Owner or Operator:Cert ficahon of receipt othazardous materials covered b a <br /> C7 ;U <br /> y the <br /> manifest ekco C N <br /> pt as noted fn Item 18a -0 n <br /> Signature D Q <br /> 1.3-05) Previous editions are obsolete. <br /> � Monih pay 'e = p <br /> (CD <br /> ° DESIGNATED FACILITY T (IF N <br /> 0 DESTINATION 7 o <br /> o S !#TE REQUIRED) w <br /> cncn <br /> s o <br />