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M cn M cn <br /> (D = 3 <br /> CD W <br /> O v <br /> CEGD O No <br /> -T1 �go <br /> — <br /> 0 <br /> o <br /> a fn v <br /> t°I,rasr n`�rn or type F 0 O <br /> UNIFORM H f orm desr ned rot use°n Nile W <br /> 1h4137E MA F�sr 1 cenararu.ro Numeef2 pi3ch)tyPywnlsr) CD <br /> cn <br /> 5.Gerreramrk Name and Ma; 7 <br /> n(+Mdm aue r ur <br /> ..e7� Z <br /> 11 Ganeralo✓s Pnorre; +e+wMrre O i 1 1�rP <br /> fir � rear <br /> ranap°rter eu — <br /> `� °mPenY ame <br /> '.iranspprypr 1 Company Name O <br /> 7 <br /> e Designated lr w't..' S <br /> aGlW Name ark Site A°eress �` <br /> U -PA et <br /> FaCilil'S Phone. <br /> US Eqa rp <br /> 9a. <br /> Nb <br /> uS DOTS O <br /> d <br /> Hill anPacking Gnzo y PNon(rnGyding Proper 6hi <br /> t P(if enylJ PWng Name,Hazard Class.10 Numhar 7 <br /> K � <br /> � ifj Gnnyinay <br /> 77 <br /> rX Nn 11 Acle' 1�',im /-� <br /> yr iYpe G4anlrry ry. 'P-W*in0ey l J <br /> 2 <br /> D <br /> 14.Special Nantlling lnshuctions and Additional inlormai°n <br /> 15. GENERATOR'SfOFFERO <br /> marked and fahefed/la RS Ind ,I,,all :lhere6 d <br /> J A carded,and are in all res y edam trail <br /> l he contents of this cl foronsignment are full <br /> FxApder,lcertdyfhaf the contents p(}his consignmenlrmnloPmrlo tthe terms ofahe attached EPq yand accurately de5crjbed abaveb <br /> Ff l certify Ihat the waste minimization statement Iden I in qD CFR 262 27 a p d according la applicable intemafienal and national governmental reyupr radon 1pq� <br /> GenerarotslONerur's pooled Ackno'xledgmem of Consent <br /> yped Name {I{it l am a large quanli a^c l am eye <br /> ty generator)or(b)(if I am a small quantity generator)is tma <br /> rgna ure <br /> � 7"o.International Shipments <br /> Transortimport to U.S. <br /> er si natu a for ex its and <br /> 0.' 1r.Trans rgcrcnowfedgmMaEr Pop from U.S. Port of enlryle.e <br /> w Pndeent of Receipt of ledafs _ <br /> transporter f Primed/Typed Name Dateleavin U.S. - <br /> 4 <br /> cn Igoature <br /> C Transporter 2 Pr,tadRypad Name I <br /> i <br /> ~ Srgnalure <br /> 19.Discrepancy <br /> 78,Discrepancy Indication space <br /> ❑Quantity <br /> ❑Type ❑Residue <br /> ❑ParDal Reiecyon <br /> ti78b,A7lernate F �-=FOR R"dw <br /> J acilily{orGenerator) <br /> Manifest Reference Number <br /> U <br /> U.S EPA 10 Number <br /> a Facili 's Phoney <br /> W 181 Signature ofAllemare Facility>Y(orGenaratori <br /> Z <br /> 1g.Hazardous Waste Report Management Method Codes{i e.,codes for hazardous waste Treatment.disposal,and renycling systems) nt�,•r Da. p� <br /> 1 <br /> 2. <br /> 3. n � <br /> 20 Designated Fac pity owner or Operator.'Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a q C 0 <br /> 0 <br /> Printed?yped Name D O <br /> Q <br /> Signature <br /> 'Form 8700-22(Rev.3-05) Previous editions are obsolete <br /> CD <br /> N <br /> gATCMrs 1tl !tL COPY ni <br /> 0 M <br />