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Adak <br /> - <br /> (D U <br /> —4 <br /> :3 0 10 (1 <br /> 1:11) 0 N) <br /> 40 <br /> M le Se Pi'llit fir I�ypc, (Form designs- ffx elit, 12-1ii I,h�lvpeivritc�r Form Approved.OfAB No.2010-00 0 <br /> -T a) -4,< <br /> UNIFORM HAZARDOUS jt P. raciling Number <br /> =r 00 <br /> cf) WASTE MANIFEST FL < <br /> 0, rl l'!. 'd Sit, in rl.111 WIWI vidr-,l 0 <br /> CA. <br /> 0 <br /> CL <br /> CD <br /> U EPA.ID flwol-,-, <br /> :3 co <br /> CD <br /> U S.EPA ID Numtrr 4 <br /> CL <br /> 0 <br /> 1��cnpti�n vncl,iang Proper'�lrpoing Name Hazard Class 10 Number K)I"Nalf Prs 11 T, <br /> 'Jirrt <br /> Dol: , . . ,'- <br /> I Pa.1'ri C'r,utt N: T,D� oja-* <br /> :3 <br /> fy <br /> < �D <br /> 3'IT 1-10 JT aril AOU[Val WD"rall", <br /> GENERATOR SIOFFEROR S CERTIFICATION I hereby declare that the contents of this corisigrcre't we'. 5,a a—Ulale ,esuitbecl attieve by the proper shipping name,and are ClaZ"fieJ4 PaC'S;ej <br /> an, and arew all respects,n proper condition for transport according to appicable international and national gD%emmenLal regulations If expod shipment and I am the Pqm�rl <br /> 1-1—rfif,`thol in,-ollells of this:0"s,,rrient conform to the terms of the attached EPA AcOov,ledgment of Consent <br /> lerilified in 40 CFR 262 27(a)(if I am a large quantity generator)or ib)(if I am a small quantity generator)Is Irje <br /> signature, <br /> L <br /> ❑Export from U S Pcrt�f rritr�,'exjl <br /> Date leavro J S. <br /> Uj <br /> 1— .: , Signature Month Day 'el., <br /> T <br /> Sprature Monti, C ay tear <br /> L]Type El Res"Jue ❑Partial Rejection ❑ <br /> Ful,R, <br /> KldfideSt Reference Nurnw <br /> U S EPA Ill%nitol <br /> LL "rail' <br /> 03, Year Wea, <br /> f7 14 Hac:ud,yn 4.1,k 1-t b,ha.:do v,om,i ,i cimq syslolls I <br /> (D <br /> 0 <br /> 0 <br /> I j"aled Ta,inty covered by _ql, nrA.1 r.L-lir 1".) <br /> rite 11 yi•e Name. <br /> Ne, <br /> "I'll 00 1 M w U0 <br /> —5 <br /> (D EPA Fofrri(Rev TO <br /> GENERATOR'S INITIAL COPY <br /> 0 <br /> h <br /> 0) <br />