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t_ SK SHIP'## 224490334 <br /> Please rint or type.(Form deskpad fur USB an elife(12-pitta b A 6 3 2 5 7 9 0 S K S <br /> Farm Approved.OMB No.2050•fl039 <br /> UNIFORM HAZARDOUS 1.Generator iD lkxrrber i" _� 1 2.P 1 of P 1:E�aeiffe3!�T+tB+c�' NuCmbe7� �'] <br /> WASTE MANIFEST 5139 �t##.. s�—� t O 0 T J J I �J Q SKS <br /> 5.8 5. s Marne andi 1 Generator's Site Address jtf different than mai€#ng address) <br /> Fit�tT313 F <t7 — L4t17FV <br /> 845 E Pine St <br /> I..ODI GA 91-5240-1-2108 <br /> efflWator's Phone: P-09-333-6953 I <br /> 'SM"1 CRffV_WGySTEMS, INC U.S.EPA ID(+lumber <br /> TXROOOOS1205 <br /> r.�'�P� z�� I`I�V I R4� E�iTAL 5�1 I u.s.eta m Number <br /> @.Desgnated Fac�ity N uneand SMAtfdreu INA IIO2250 <br /> 3 MILES EA§T,MRS i�3#��L S�f�T14I1'I U-SEPA ID Nurnbw <br /> KNOLLS EXIT 414 OFF 80 <br /> 435-884-8915 KNOLLS � UT 8408 <br /> Fadi s Ptane: UTD99t30174B <br /> Sb.U.S.DOT Description(indL*V Pmparbriny Name,Hazard Gloss,ID Number, t @-Gon#airrers <br /> HM and P-khV Group(Sorry)) 11.TOW 12.Unit 18.Waste Codes <br /> �PIB50RBENT AND OIL)1- Nl�l�t P#A HADA 6�A �'E 50t_IIIS4 DM P <br /> No. � �n.tv�. <br /> w <br /> k7 <br /> u� <br /> t3 <br /> 3. T <br /> A. <br /> l <br /> 14.Spada$iark'ng NlslrWbons arHtAd f w IMOrCnaa@on D 79696g57 TA479SA CSG-. <br /> 24 HR EMERGENCY #1-800-468-1760 (C4 ! SN 1 TFT) <br /> SEE F�tATOR'TTACMENT �G? <br /> 15. GEN SMFFERQR'S CERTWlGAn Nt: t hardy dec;We drat the c mtents of Mis consignment are fully and accurately daararboct atr)ye by the proper slsippirtg name.aM are <br /> marked and labe€ediplacarded,and are in al respects in propercm ddion far 'Aternafiona <br /> Exporter,S cert that the co de its of d is cons grunerst conform to tna terms ofedattachad EPAAcknatxiedgtnent of Conserv d natianal go rt n3niertfal r8gtila§orts.if Bart shynt and t am the Primary <br /> I carriiy that dre waste min 'zall0n identifred in 49 CFR 252.27(a}€if I am a kvge quantify gefwabr)or(b)tdI am a srnah quad is trite. <br /> Generetor'sr e s PrtntedtT N Signature / tuf]fir Clap year <br /> ._r 16.En iprrtenf8 r--� <br /> Impost to U.S. L—!Expo€t from U.S- Port of entrytexit: <br /> Iransporter signature(for exports }' Date eavirrg U.S,; —— _ <br /> 17.Transpo4torAsknowss'ledgrmnt Of 4w pt of Matartals <br /> W <br /> Signature <br /> Manch t7ap Yea <br /> C Month Day YOW <br /> 18 Oiscrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouat city Type ❑Residue <br /> ❑Partial Rete u. ❑F Ai Rejeclan <br /> 18b,Alternate Facility(or Generator) Manifest Rekererfce Ntxnber <br /> .r U.S.EPA ID Number <br /> LS <br /> Feduty's Phone: <br /> W 18c.Signature of AMemete Fardity(or Genera€or) <br /> Marsttt Day Year <br /> 19.Hazardous Waste Report Managemerd Mettvd Codes ti-e.,codes fa hazardous waste treatment.deposal,and recycling systems) <br /> d 1 4. e <br /> r <br /> @,Des gnated Fac tity Gamer or OW&CCcxlthcapon o1 reaerpt of hazardous matsrtala wvered by as torted in Am 18a <br /> Pri'w NltvneRyv <br /> S editiuN are obsWete. GNATI=D 1"AGIL! 0 C31 ST1�1l1TION STATE(IF REQUIRED) r <br /> r{k <br />