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Please print or type.(Form desi ned for use an elite 92 itch '_ "' _-:•0� 9 ( P )typewriter.) _ ? -y�.q.2 " -- Form Approved. �• f1PlI�FOR2M ue?nannt to 1 Generator ID Number - OMB No 2050-0039 �-t- a r eeinenu- . inannrrarrraerrn+g(rmuitretC C---� wflS t E IIMANiFEST •,. t1 t? =J ! 's u s �! 2 a Ei ;-1'1 O O o 9 5 f 5_Generators Name and Mailing Address Cerentor's Site Address(if different than mailing address) :2t :�!•a�' ,Ole? yy j,r = ✓ I�Aw? Generator's Phone: "`-d is ' ;y: 6 y+ '°):=?yE;3a 6.Transporter 1 Company Name U.S.EPA ID Number C'e3n;arbors ? 2 2 5 G 7.Transporter 2 Company Name M D0203 U.S.EPA ID Number 8.,Designated Facilityljae and SiteAddr�sg U.S.EPA ID Number v. 3•.l..3 C Qrs•_3D D5�_L_ .�A-'3533 Facility's Phone- 9a. 4ti1-193: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Und 13.Waste Codes No. Type Quantity WtNol. a• 11Ji'! u5rliJatp�yl�rClC'i_i_i! � . Li;/)I 1=-D rDU.A1 !)N, 0001 -43 � D F 008t, P w LU Z 2,.; 1 f`93.14"AC S FLr?NC a.E(P L1QUI r-;5,N.tD3-.AU(IL ALCOHOL Din 243 ?C Fr-"aKY1 aTE-,ALCOHOL0ENA7,jFED).3•R011 0 0 1 D F 0 0 2 0 P 3J''iAS ME X1jJ'ZiN Ltil�LLj.y4.r r *1`✓'��){j�`f ^. FEROADE,SODIUM PERCARBOvATE),6A,FG 11 0 0 ', D F a G 0 5 P DCu9 141 41J :".,. ~ r . , -'F-,A. „n tNf, 3,(n LP'1 J A'E,:. PRET: IN!,j3.1,PG 0 � ' i � � r ° 14.Special Handling Instructions and Additional Information 1. LL'v�?r1 LP 1X300P 3. LwC?r, rBp I1✓ n .,.veV.yF`L+-1, 4 � C . ^iJ i� if.'r�+.�4 FLEET 4. L4t+�si r r4 L`= �13d �- n 2 .a4 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generato 0 eror's Pd-nt-077yped Name igna r on ay ear 1 C ' \„//W/ aF - , 2 OS _� 16.In emabonal Shipments i ❑Import to U.S. z ❑Export frau U.S. Port of entry/exit Transporter signature for exports only): Date leavin U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name gnature Monthay ear a P?ter Huang 13S Q r5 1 ?Transporter 2 Printed/Typed Name Signature Month Day ear Ce t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: J U.S.EPA ID Number U Q LL Facility's Phone: W 18c.Signature of Alternate facility(or Generator) Month Day Year Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Phnted/Typed Name nature Month Day Year FePA�Qrr��7Q0�^r5(Rg�3�Q��f�viQLLs,e�it�to�e`��,°p�Q1��e3% �,;=_� _G'`�-•-- _ _-';--��-- , sc':- DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)