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Please annl or lyprr <br /> Form Allprovr!:1,OMB No 2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2 page 1 3 Emergency Response Phone 4.Manifest Tracking Number <br /> uu <br /> WASTE MANIFEST :1 1 a317�d94 JQJ4 58493 FL <br /> • a^n . mss man r,-mlro address; <br /> O'a,%,UNS BR,)CKvW'r" 3iA-5 uN tAj1`11:-R <br /> 14700 (--HULrE- <br /> Fit_'f>�, <br /> RAC"' CA 46J715 <br /> ",unar 4or%PHune. 1 1. + P <br /> Traricporfer t Crsmpany Nam-- ;.1 S EPA Al N itiffir <br /> Ef 1:,IR )f'lEaEi�lf"A.l .�+�h�!i``�L '_ �''7SUi.TIi"i;� � R. 0 D iT i 1 u <br /> 7.transporter z Cfltsrwrty Names <br /> Os:PA rD Number <br /> ;;irate!Fruity Nawr and%e ArMfv!.• I S EPA ID Number <br /> Caiit,rria -all Trap4er <br /> ,;3'n0 c4is Rif <br /> Rjvetiaf-+ Gr' �539 i <br /> L :J 0 •1 J 13 ) i5 <br /> ga 9b U.S DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10 Containers 11 Total 12 Unit 13 Waste Codes <br /> HM and Packing Group(if any)) No Type Quantity WI Not <br /> IFIQN RC_pd HACARL�• il`= 'WSF Ll'�U!C) t•)1r-` '1�aa'ER1 Z ,p'=(] ��" <br /> a - _ - - 4- <br /> x 2 <br /> w <br /> 0 <br /> 3 <br /> 4 <br /> 1.1 $jMri�dl(+9nWinglristluCl,vnsan,lArirlillmpt lnforma6on ERG#q 5�49 01L, 141,+T ER FRCdI ERG*154 Y%Y(--M i5/9 <br /> EPr=#1501 ER„*15C 01L_Ei-,C, F, ;_, F1l=x �2aq,'--RESTL'1`4E <br /> Oi)r 71T <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of[his consignment are fully and accurately described above by the proper shipping name,and are classified,paCKaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262 27(a)(if I am a large quanitty%mrgW)or (if am a lily generator)is true <br /> la+'s'Olfar4rs�rk"f pit L� r !ri rdtyr„ � rks,rth Daf 'v:r• <br /> ( {�J l I -'env �If <br /> J 16 in national Shomanls <br /> ❑Import to U S ❑Export from U S Port of entry/exit. <br /> ? Transporter signature(for exports only;: Dateieavfrig U S: <br /> 17_T,r , orter Acirrxtvrl merit of Receipt a1 Muria S <br /> Trwispertw.LWntedlry➢cv!Nf'rr11EE <br /> r d .�.rri r �i fr /e+t- a G Z <br /> z rriw9p0 ar 2 PrWedfryped Name — Sign Month Day <br /> Qd <br /> 16 Discrepancy <br /> 16a,Discrepancy Indication Space El QuantitylJ'.,.: _ Residue Partial Rejection El <br /> rinnrr,•.!�1?nh�::•re Nlrmder. <br /> C tetr A1lamtiw Facility(orGoneralar) <br /> rI; EPA ID Number <br /> J_ <br /> V <br /> wf,;y,Phone: 0" ifl <br /> F8c SignakaC 4f Alternate Faplity(br Gefler4t6!) hAonth Year <br /> W <br /> I <br /> 19 Hazardous Waste port Managuntent Method Codes(i e,codes for hazardous waste treatment.disposal,and m yrding s"rns) <br /> C 1 Z 3 T <br /> 20.Dbngn+rGd Facility Owner or Openstar, :c•tlf r rrsx, rnc•=:,'of i,n. materials covered by the manifest except as noted in ' •16a <br /> Pnniedirryperl riarnrr t i;hn ff lk,nm E,y r <br /> o <br /> EPA Form87M-. (Rev.12-17) Pfevouseditions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />