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SK SHIFT# 221`91097'. - ! . <br />Please ,rin(oc� <br />P Pe {Fwrtl dAslgn@d for u, a on elite (12 -pith) typewriter. <br />!t' . • ` UN1�01-- fFAZq(Zpp{ 9•.Gene a:or IDNumber 2. Page 1 ofQy¢ppag. <br />WA$rEMANI EST C,AI.Kh(�tl1t� t�t394 L1_ 1- ril0la-4bt3Sel I�i� 4 ManitestTre <br />:N <br />5. Genefatofs Narita and Marb'ng Address — �-W �• <br />F erguson Generatofs bAddress(ifdifferentthanrnaiNngaddress] <br />5?® Port Of Stacl tnr Sf <br />6. Trans 1 Co Na e <br />SAE Y—Et� SYSTEMS INCu.S. EPA Io Number ---� <br />�J 7. Transporter 2 Company Name <br />TAX R17-'0008.1 205 <br />�� , /,�,^ t,S. A p u r <br />ty �a3�l1aX <br />6. Des noted Fadli Name and S@e Addie s <br />CLEAN HARBORS AR GON T TI= LLC U.S. EPA ID Number <br />11600 NORTH APTUS ROAD y <br />1 ARAGONITE UT 8-(tVIPq <br />4-35-884-6100+ <br />Fadlttys Phone: <br />UTD98155"c:177 <br />9a. 9b. U.S. D07 Description (including Proper Shipping Name, Hazard Class, ID Number, <br />tIM and Padding Group (if any)) 10. Containers 11 Tota( 12 Unit <br />t' X 1 3 WAS. _ No. Tyoe 0-4. mm. 13. Waste Coes <br />t MCI, 96, ncli <br />X 2 UN1993, WASTE FLAMMABLE LIQUIDS - <br />N, (ETHYL ALCOHOL) , 3, Pr,! I I 1 DM <br />% E^� P <br />1 (4� <br />.1N+t19�13 . DISINFECTANTS LIQUID, <br />tARFIVE N.O.S., (QUATERNARY AMMONIU CF' fl P 141 <br />M 0 POUNDS), <br />t 4. <br />1 :Special !�, Arg IhWhichons and Additional,—.....—, — <br />TSD:AG 73280787 FE1.2463 CBG: <br />`1)ERG#153.2)Ea(3#128"3)ERG#153- <br />24 HR EMEAGENCY #1-11180-468-17910 (SK ! TFI) <br />5 ATTAEHM NT <br />15. GENERATOR:WO FFEROR'S CERTIFICATION: thereby deciam that the contents of This consignment, ire fully and accuratety described above b the Toper shipping marked and (abeled/pfacarded, and are in rill respects in proper condition for transport accordin to a y p Pe name, jird ate citassified, packaged, <br />Exporter, I caitify that the contents of thus oxrsignment conform to the terms of the attached EPAAckn wlleigment of Constentd national governmental regulations. If export sh pment anmbrn the Primary <br />I certify that the waste minimization statement identified in 4o CF17 262.27(a) (if f am a large quantitygennrAor) or (b) (if t am a small quantity generator) c; hue. <br />Generatofs/O ferries Printed typed Name — <br />S' nature <br />L�RA>�E S//✓ i r .Day Y�r <br />1 16. mationaf Shipments ^ l✓ <br />❑ Impod f4 U.S. <br />Transpo ter signature (for exports only):❑Export from U S. Port of ry/exit: ) <br />17, Transporter Date IeevLng U.S.: i <br />9ment of Race" of Ma edals <br />rDis-pan <br />d Typed Name �/ <br />Signature <br />S] r <br />/= C><dication Space <br />❑ Quantity ❑Type ❑Res due�— ' <br />❑ Part at Rejection ❑ Fulf. Rejection <br />r— 18b. Alternate Fadlity (or Gerreretor) Manifest Reference Number: <br />J U.S. cP4 iD Number ~ } <br />4 <br />Faddtyb Plane: <br />Q18c.SignahxeofAhemete aalfty{orGenerator) — �` <br />Z MonthDay , Year <br />UJ19, Hazardous Waste Repo t Management Method ;odes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) I <br />UJ 1~� <br />D 2. _ <br />ay b <br />3. <br />up b i <br />20 Designated Facility Owner or Operator. Cerh'ficalion of receipt of hazardous materials covered by the manifest axcept as noted in 18a I- <br />Printedlr dName <br />o ` ._ <br />Signa�iY <br />EPA d' oPout r ATr--9: 3) 7"�94a7� LST1NATION'STATE (F R! <br />UIP�frWrD <br />I <br />; <br />