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'43k SHIP# L-16S4990s, <br /> P1 .50 piintur type, Fon designed for use on elite(12-pdch)typewdter,) <br /> UNIF.OAM tiA7.ARL1pUS 1.GarlomtorID Number 2.P 1 of 3 E e e Form Approved.oMB No.23SU039 <br /> f4 �1C3491 J, a ` ° ' e �,ManffestTreeitfn umua� <br /> WASTE MANIFEST. 'n! {��� SKS 5.GeneraloesNamaaad llhlpAddraw DID, 60' <br /> beneraton's SAePddms Td18erant Then mailing address} <br /> Lk1 °•(-r 11': ) _ lo— L.urls C }.—'irate �rttra{� mak :wrtJi <br /> Garrerators PtgnaO:�T ark Qa �3 W 6 r :3 <br /> Lod <br /> 8 f�e C 14C.t t e}ysi rpis r .I}yf _ J.S.EPA Ib Nembar <br /> T)SC!�tir`'�fls�:r.i't3xa <br /> 7,Transpaler2 Company Name <br /> U.S.E'PAID umber <br /> e.f]eafgnetedFacififyNameand9ileAddress rsltF�!Y�}�LE 1�k Y T ;lS_ ]Hr" U.S.EPA IC Number <br /> 6000 98TH STREET <br /> FaalitYs Ptwne: <br /> 98, ib.U.S.DOT Dw-dp';€on Qnduding Pqw ShiWN Name,fiward Gass,ID Number, 10.Cantaina a <br /> HM ardPackirg.Grcup(fany)} ti.Telsl f2,Unit <br /> No. Type 4uanuty Vytft. 13.VJasts Codes <br /> I.fqulq-RCPNA HAZARDOUS WYUTE, L:qui!)0 (AQUEDUS BRAKE CLEANER) AF S % t 7� <br /> t7 (AGUEGUS PARTS WAi}}ER SOLUTiifi!)? <br /> i <br /> 3. <br /> 4. <br /> OPM Flaodfn9 IngRicbms and Adchonal Inirxma8arr e r <br /> C:,'270J 2()iS3i l'wr);2=t ' <br /> tri HR ENgRO7ENCY 01-800-468-1'7,6V :67Ai.�T, -:E�fl r - <br /> S� AI �f�ORia.0 TO RETAINLICENSED 51,f�=i QUE T" GARRXERZ A6. f!1y.,CE'10 AR'f 6��-��-. <br /> 1S. GENERATOR 810FFERUR 3 t+SftT€FICATION:i hetehlr tletlare that 1ha contents of ih€e canelgmsnt we fully"d ar�yrfat@ly desedW 84611e by Uw plapar amppirg come,end ars dassiwa—Oed, <br /> maftd And labeleNA€acerded,and ere'in all mspeds in proper cord ilon tar benepOn aCM&g to appilrabla ln(amalloWand nsllanal govemMgntal reggl Ums.If- <br /> Exporter,€rxx*1hat9t.6bp>denta of Meaxlgi!ment conform to the lemis of the eltaetted EPA Admovriedgmant of Cendant export ah'�mentand I am ire Prhnary <br /> I certify that 8tatvaste m7nimiraltan etetement identified In 40 CFR 26217(g)p1 I am a€ergs quantity generator)at(b)(if t am a small quantity gesaEramr' true.Generat�'e1 da Pfrntei!€T ems <br /> M h Dey esr <br /> (rA 11-1 L--- "-I L1�< <br /> A.tntemallanal.StTIP <br /> O lmpnn so U.S. ❑Exparttrom•U.S, - - Port 01"W"t <br /> Transporter 9{nahse(far evprts pnl# date leer rrg tJ,$,: y <br /> ry 17'Tia�sAoiterfScknuter}gtn5fit5 ReoelptdiMatarets <br /> Transpor ar' a yp' <br /> r.. Sxtnature - tAortth. Day :'Year <br /> T 2 me <br /> a 94gnalure wwa Day Yea, <br /> 18:D1a:xepancy <br /> 18a.oismapancy IndiCaton Space ❑ IIuantity ❑Type ❑Residue ❑Fedi Re)ea8on <br /> _ ❑Fu'I Re)ection <br /> Manifest Reference.flumbo; <br /> i0b.A temate Fac!l<y{or Generator) <br /> J U.S.EPA iD Number <br /> ua. Facifibf&•Phoria:` '- _:r.,.:::::.-:�,.:_. � ,.. .� <br /> U 18c.S€gnstureofAltemate Fa-07Y jar 4werstar) <br /> } Month Day Year <br /> tg,h{azsrdousVJ�ta Report Management l�eShad Codes tis„wdea far ha udws waele heat nano.deposal,and recyft systema) <br /> t $'t 141 2' f4 14 t 3, <br /> 4, <br /> 20.t)eslgn aa7iry fiwrrsr a Operator Csrtilhal m1 d receipt of hazardous materials Cowed by the manifest except as nded in I em 18e <br /> Prfnled me Signa€urs <br /> Man <br /> EP $ J•�22.�epQ , <br /> f c <br /> �.3�5 <br /> DESIGNATED FACUTYTO GENERATOF <br />