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006135821SKS <br /> Please print or type.(Form de ned for use on elite 12-pitch)typewriter.) Foy <br /> Approved.OMB NCa-2fl54{3G3f3 <br /> k1f11FOR#HAZARDOUS 1.Caaoeraiar i0 Number 2.Page 10f 3.Ernerpertcy Rorrea Phpns 106116821 <br /> nIRV�� <br /> WASTE MANIFEST <br /> Generator's Nor*ani Maipng Address Generator's Site Address pf different than mailtrlg address) <br /> Gsneratars Phone: <br /> 6.Trapspoite,1 Cwrwy.ame... U.S.EPA ID Number <br /> T Trsnsperter 2 Gompany Name U.5,EPA It)Numtrer <br /> S.Designated Faddy Narrre and Sita Address U.S.EPAID Number <br /> Faraf 'sPftare: <br /> ga. 9b.U.S-DOTDesra"on pruning Preps Str"l Name.Hazard Class,!D NumM, 10,Cortlarrere 11.Total 12.Una <br /> HH and Packing Group(d arvy)) No. Type t]traatily WtJVW. 13.Waste Codes <br /> i. - <br /> Z. <br /> �, <br /> 3. <br /> i <br /> i <br /> i <br /> 4. <br /> i <br /> '4,Specter Handfmp Instrua' s and Atda"al 1rlfeamallQn <br /> b � <br /> 15. GENERATOWSPOFFERMS CIERTIFICATION:I hereby dsdam hat the convents of Nus consig,ntrit are hiy and accurately&saribed above by the proper,hgphg name,ark are dashed,pad gad, <br /> marked and tabeled(plamrdad.and are in al respects inprepw oe W%bon for Un4 W accotOng to applica*l N!etttttdorlalEd naNanal gtryemmerdat regufasirM.Ereltpbrt sh Ilmarrl and I am the Primary <br /> Exporter i certify that the contents of Nrscarisfgnmerl cortWn to the berms of Nte adachad FKAt oMedgmant of Content <br /> I cerfity h9ft waste mh+m4atlon sialentere ida tifed n 40 CFA 2620(a)(g t am a large queruty Weraw)or(b)(if I am;)srrW quantity generator)is ave. <br /> Gere:akrslOHeaefs nt ypedName S natusa Atomh Ny yew-- <br /> 2S 9, <br /> ec. 7 <br /> J 1v trdemabpral pmeats <br /> T. ❑Import to U.S. ❑Export from U.S. Port of.tryle� <br /> ? Transporter%natare(foe experts cnsyj Date keving U.S.: <br /> s?.T€anrwwAdrnowtedgrrlem of Rao*of Afatemb <br /> O T a rtPrirded Name Signature worthy 1, <br /> j:z rens 2ted`ypedNaw SpInature A N Day You <br /> 18.DisnePwwy <br /> 19a-Discrepancy Indica tfooSpace ❑ Grranidy ❑Type ❑Residue Ell Parnas Re a uon ❑Fuer RswAw <br /> Hardiest ReferOM Number. <br /> ti3h.:Ntcrrrato Faplity(u Gettarator) U.S,EPA ED Nvm6ea <br /> U <br /> LL Fardir?s Phwm- <br /> f&,Sgnat�m ofAk male Farafity(or Generata'l t0n#r Day Year <br /> x <br /> 19.Hazardous Maw Report Managest nt HeNrod Cedes(i.e.,codes for harar&us wasta lraatment disposal.and recyckng systems) <br /> 1. 2. 3. 4. <br /> Designated Facafdy Oconee or Opmallor:0ea$1t GWD 01 tLtiW of hazardous matarlals trnrered by the manffjst a mpt as rwled fa Nam lea <br /> P yl� 5 l r mom (fay Year <br /> EPA Fars 8750-. ( ) re, editions are ere. DES)G fit' EO FACILITY TO DESTINATION!STATE()E REQUIRED) <br />