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Please prin#or s,(Fgrgt resigned for use on silts(12-04h). ewri3er.} Farm APPCgved.a3v1E No.2450-0Q39 . <br /> i:fene#at�ONum6er" 2 P i151AM <br /> nayR s se ne 4:. ant€ebtTraid ngNunlher ^� el]NIFOR�i NA2AR c3i7s LU'�112 1MO 100-5-14 4 .5071 �7 <br /> WArsTE NmANIFE,ST <br /> S.Generator's Name and Mai fng Address Qenerata�s SileAddress AU <br /> Q1 tliitarent than melT'no addross} <br /> 1'r7-Its I.-'hup 10.' Led'.' �st�"�4�1T'•i �l'iT$� 1.0- {»t2t#:i <br /> ;;oa %",4 'S' .84S E #alit- St <br /> �.S THES r.11' CA �E 1?06 �" � <br /> Genaratnr'sPhana: --�Q�"'� �^�►��,`� �»t.7tf1 CA ���24 '-31��+� <br /> U.S;EPA ID Number y � <br /> 7.Transpoder2 Company Nemo U.S..EPR t0 Number <br /> S.•DaslgnatedF6FiityName and Site Address -AFEI'Y-ME N SYSTEM, 'M2, U.S.EPAiDNtoriber <br /> 89-TO TWE'T <br /> Facrm k Phone: <br /> 96.U.S.pOT pesrriptfon(#ndudir g Proper Shipping Nam,hazard Class,ID Number, 10.Containers, if.Tolai 12.W.A. 13.Waste Codes <br /> and Pas og Group Cif am)) Nb. Type. Quantity YVt lVol: <br /> I. MON�ROKiA HAZA00US WASTE, LIQUID <br /> c A0tit- US BRAS CLEANER) <br /> '15 7- 1- WiDN-RCRA HAZARDOUS NIUE, 41OU10 Or <br /> 14.81 ectlHandling 1nSlNdionS andAdditimai intonation ��L);i�� � ��'����� {'r�a�Q%a o i S-o-{-s?G-4:an <br /> 5613 q k 1 . <br /> 15, GENEMTOR'SIOEFEROR'S CERTIFICATION: I hereby dadaM ttiat the 0110ls 011111s cans!gnmentare atlEyaod accurately dqb ted above by the prwar.shlpping narrate,and are Wajatl,pad(s:getl,- <br /> marko uric!Iabatedlplacerdad and are isralI respects v;proper condition far Mansporl accarding to app5Cayle'Interrtalfonaland national governmental ragufatians if expnrtahiprrield and I em the Primary <br /> Exporter,.I certify that the.oantants of this conslgnmant conform*the terms of the attac�ed.EPAAcJarovRetlgment of Gonsent. <br /> I certify bat the waste miornization statemsn_1 identffed In 4D CFR M27ja)(ifam a largo quantity generator)or(b)('sf a small.quanW generator)Is true. <br /> Ge its s fads Print Y*flame. Signature .^ Month Day W <br /> r_l16.international Shipments <br /> u Impor,to its Etgtori itgn U&... i .tT3itof.entryleldt <br /> Transputer sDgnalilse(far expats tHrty): Dam leaAmg U.S.: <br /> 17:�ransportarAdmrnvEedgmentofR_ece;pto€Materials <br /> T er1 PrintedfTy Name Slgnaurrs <br /> Month Day Year. <br /> W Month Day Ye <br /> d Tran orter 2 Printed yped Name Sa)rratu a ? <br /> L� <br /> 18.Oiscrepanq <br /> iBa.Discrepancy Indinilon Space Quantity O TYP ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Rafarence Numbar: <br /> 16b"Atternata FBaI1)ty(dr Generator) U.S..EPAia Number <br /> .'F?4j!Y,$Phone: <br /> in i6c;Signature nfAlternateFacility(o(.Gertar2tor) nth Day Year- <br /> i e.tilazardass VNaste Report Maagement Method Codes(i.e.,codes;1&,Mi8rdou6waste tiearrlteri"I'sPow,and reeyclfrrg systems) <br /> 2. 3, - 4.. <br /> X1141 <br /> 20.Designated Faalp Owner or Operator.C 'ie2tbn of receipt of hazardous materiels covered by Mss manifest except as nded In ltom 18a <br /> Printedflyped Sigrature -. Month Day Year .r <br /> EFAAi'orrn,370422(Rev;3�4r5� Prisvousq�e}ditiornsareobsolale. ESIGNAT i3FACILjCY DCiENERATQR <br />