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Please Print or typo. (Form designed for use on elite ( 12mpik;h) tyfi4,vfiibr} Form Approved- OMB No. 205MO39 <br /> UNIFORM HAZARDOUS 1 Ct nr_.rnfrs If? Number 2 ilaltu I of 3 . Emergency Response Phone 4. htsnifost Trochialf Ntunht <br /> WP MANIFEST A ' L 0 'J ; :I. r '_' t3 ;3. ,; ! {Si)Oti -�z�i- sQo o 3 7 1 JJK <br /> 5: Gtsneaator's Name an tial rn) £+c,drr;t Gimoratoes Si:e Address (if d foient Shan mailing nthIms5) <br /> JIFFY LUSF i?Lju ! <br /> 14 / ; HO LSI r- i o - 4 t- 1 !. <br /> 4l �.5Nt ' VESTLANE I`, 0fNIlIL`i 'EIt L tIel <br /> Generators Pltora: <br /> 2Q19 959,- 14 6 rOCK T ON <br /> 8, 7ransptn-ter 1 Cmilpatry Name U,S, EPAJD Nkim (oi <br /> ASEU „`r" ENVIRONMENTAL c) 6W ;;E5 C ! O t} s' 3 2 7 7 2 „ & <br /> 1. Trios o-ofter 2 Cs;mporiyNafria U.S. EPA to Number <br /> fl;1)t.;,fgn ilud Fa(flily Nanta and Site 1lddro,,: U.S. EPA ID Number <br /> ASBURY ENVIRONMENTAL SERVICE CERES <br /> 1920 MORGAN RD . <br /> CERES f,H 9b_3 5 CAi_ 000 <t93 €•> t, 0 <br /> { acJliPy s Pfior;e: (209} 4-1 w1*825 <br /> ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, to, Containers ii. Total 12, Unit <br /> 13, Waste Codas <br /> Hhi and Pacidng Group (if any)) No. Type Quantity WtNnl. <br /> (. NO N- RCRA HAZARDOUS '':tASTEt LIt1UID ( OILY V�+I TER) <br /> 3! 3 <br /> W _ I. me” ._. . . <br /> 001 TT G I <br /> W 2. i <br /> LU <br /> E <br /> 3. <br /> t <br /> 4, i <br /> f <br /> mom <br /> f <br /> 14. Spei .al tisidiing irtsifut#ions and Addiforlol Infliwmirn <br /> EMERGENCY CONTACT : CHEMTREC :1-800-424 -9300 WOES TERMINAL CERES 1wS `rk FR PRI ATUEI 8C�V) WtL PROTECTIVE <br /> EQUIPMENT * EMERGENCY CONTACT CFIEtATREC 300-4249300 * TRUCK # ��,�I � <br /> 15. GENERATOR'$IOFFEROR'S CERTIFICATION: 1 hereby dedare !lilt the contents o1 this consignment are fully and accurately described above by the proper 6hipping name, and are classified, packaged, <br /> marked and labeledlplacarded, and aro In ail mapnrf, in proper condilion for transport according to applicable international and national governmental regulations. If export shipment and I ant the Primary <br /> Exporter,f cortify that the contents of this consignment conform to the terns of the attachna: <br /> ed EPA Ack +fedgmenl of Consent. <br /> I cat'a',y that the watts minimization statement Identified In 40 CFR 262.27(x) (if f am a large quantity vncr,YSe) or (b) fill am a small quantity generator) is true. <br /> Gene70foi t 9 k c Ty) .tl me an r hdc9 . >fy Y <br /> tiAV�"\J G {` T <br /> ..-r 18: 6fttlei �idpmeq(S II _. <br /> F U Import to U.S . U Expart from U.S. Pori of entry/exit <br /> Trot :j ester sfpitatiiie (.'ac axparts onhy)° ata leaving <br /> tee 17, Transporter Acknovrted mRnt of Receipt of Materials r <br /> Tran x rmr i PrintkilTypad ante S t�.l �..t� h1? y tr Day. 1 art* <br /> ww <br /> Trans},oder .) Peint.d/Tyttedkmio feature Me* Day 'for <br /> t-- <br /> 18. Discrepancy ii <br /> 18s, Discrepancy Indication Space I _1 Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manlfest Refem%c Piu o ra <br /> 191), Aherrrata Pwi lily (or Generator) U.S. EPA ID Number <br /> iJ <br /> u�r FxAt0' Phone; <br /> W 184. a;goal uiti of Millfv* FrsciRy (or Cienef Als) ' ih Uay Yat <br /> d <br /> 19. Hazardous Waste Ropod Management Method Codes (i.e. , codes for hazardfous waste treatment disposal. and mcycting syslcole <br /> NINE <br /> b i . 2. 3: 4. <br /> 20, 13t iUVAA acility Owner or Operator: CeitiricaCon of rece;lpt of hazardous malerials covered by the marJes: except as noted 'n Item i6a <br /> i lure �r� 14ta tt�nJr Da/ r. 'lest <br /> Pow <br /> TP riri�d7Typntf Name St;)fF1 <br /> Jim m <br /> Form 8700.22 (Rev. 3.05) Pre-, otr etlili•3ng are obsolete. :,:T....a t ,d FFt'= t _fir F6b;dl I'S'd 41:31 DESTINATION S3'A i E (IE FtEQUIREE) j <br />