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4QT9 �b919SKS <br /> Please print or we. Form x1.OMB No.2050.0039 <br /> t@Nmbv r. 2• g1 Nmmwr <br /> f ovUNIFORM HAIAwco-81'r —t� — � <br /> WASTEMANFESf 1007198919 <br /> a.caaaraatsr�aa�eanare readdre� Gv*mWd s"Mdmu(Addomelthmmairogaddress) <br /> Ap�Ip Freight <br /> r$ <br /> Genaraia'sPhona: �t•c,.',�c:i--fik''ificP <br /> 6Ti my Name - - - U.S.EPAID Number <br /> r-.s�, 4' —K1��F�1 ^i'''TI:"= IAjC: 'rYQ:fi!h°IQir^� '�.5 <br /> 7.Trareporter 2 gars Name - - U.S.EPA1D N=ber <br /> A,F!iN rTr:p{jR� rp1'# ^f'C I�t4. �6at?b__•',Ta3=.."5L? <br /> 8.Designefed Fao*Nffine and SftaAddress THFRMO FLUIDS INC US.EPAIDNUndler - - <br /> 12933 5F CARIPI~1VTER ^R <br /> C:,flCt'fiMG?� <br /> _•f:$ tTn7ic�f19? <br /> ..; F s Pfnne: <br /> 9a. 9b.U.S.DOT Desaiplion*WN Proper Shieft Name.Hazard CAM.ID Nurrter, 10.Containers 11.TOW i2,Urm 13,Waste Codes <br /> HM ad PackrQ G1OV V8nY)) No. Type ommy wuAkL <br /> 1 mot t•+rpiri HA7ARDnUB WASTr F'+tti.Il1 nr �, ' <br /> �o !7)pAI"d�D111!NPt'�?IN D uiitp hri- FTLT17R?) 0 <br /> � P <br /> z 2. <br /> UA <br /> 3. <br /> A <br /> a. Ina ON Additional ftmalion VID,TPP ,x6.()1 x-10159lf,?Iop C'r <br /> ^=trH r.M RG=_nICY#9Qtt3_.}ff-.. 7F?t—fii!�;V,!F':-C,�tta ' .,I' ""er.- by rneratnr rion�rr �. ?rs ;: <br /> 15f G£NERATOR'BFDFFf1�R'S TION:i4rerebydeclaetFWBtaca%PottsdbrNtI9rarsterakllyaa6atAadtah'dasafiwi ,M'NagropasM9Phrgn�rie•md�acAassffiad,gacka9ed• <br /> m e*W and labeteNn>acaded,and arein eM in grocer candtion fa harrepoR aaordbgbacpizaMe+nt9WWnM3ndnational govarttmantat M9UDtans.IFarrpaltdtipmentand tamthe Primary. <br /> Fiporoer;l certify t' the corttanr d chis ca�eiggnmed cdnkrm to 91e term d the eeadxd EPAAdawxledgrtrent d ConsatL <br /> I cer9ty tl the vests minis+I>�ibn s>etement identified in 40 CFR 282.27{a)(d i am a laage quargty genarabrJ b){NI a srri gUaaRy 9eneraax}is true. <br /> Generat&s40fFera•s Sig MoM Day Yeo <br /> t.International Sldpmants ❑Import id U.S. ❑Export .S. Pon d erroy1w:...._ <br /> z Transporter signeam(tar a carts only): Date low"U.S.: <br /> a 17.TrarrWAKAcim.Hadgmenr of R ofMOO& - <br /> T /t yped Namrt¢ Signator - Month Day ym <br /> as i� `>Sn y C..i •�/. ,30 1 <br /> Z do ams Month Day year <br /> }1 18.Discrepartcy <br /> 1 18a.Dscrepandy Wi atfon Space ❑Q.,ky ❑Type ❑Residue ❑Parfki!Raj O. ❑I'd Rejection 1 <br /> f11 MardW Reference Number: <br /> 18b.Ahernate Fadity(or Cwerator) US,EFAID Number <br /> V I <br /> P.tws Phone: <br /> 18c.Signature dAltarate Fadity for Gormalor Month L7ay Year <br /> 19.Hamrdoos Waste Rolm marmm era Method Codas(I.e.•codes for N aMous Waste Uewymm,disposal,and fftydrg systems) <br /> � t. Higi 2. 3 A. <br /> 29:Des~Fedb Owner or Operator:GertlkAm of rec*of Frozardous mads covered 5'P th W409 M nam&a rLJJ, r <br /> t i ! <br /> Y <br /> EPA Form 870032 Rev.1-17)Preview edMans are obsolete. p HATED FACli iTY TQ EPA's e-MANIFEST SYSTEM <br /> 1 i7R7;7F7r,1"r97 <br />