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P;eaae pn-,I t.r type (F:i,m designed Io1 use Dn dile(12-pth)ly pedlar.) Faro Approved CMB No.2050-0039 <br /> UNIFORM HAZARDOUS -`r"ate+ID h rrt.*r 2.Page t r.! 5.EmergencyRespome Phone 0.MW�Ting��U41 <br /> r ��WASTE MANIFE57 <br /> fV� '�'1F <br /> .r"•V,ian,e and M61.n A&re55 dPNwf than medhg IsddressJ <br /> g . rr.-raforsSiteAddressrl <br /> �..r.• Phone <br /> -e 1 co npany Narne <br /> U 5 EPA ID*mbeir <br /> CcmpalyName U S.EPAJD Number <br /> R 7 i Faalrty Name and Si(aAditm U.5.EPA 10 Number <br /> F:'-rte o':-ra <br /> J S DOT aeswl)tm(rd AN ftDM SNPPing XaM Hazard class.ID Number. so.Cpntrwis 11 7-t3 12 Urcl <br /> u�,q -rr'Patkmg Gro:ip(danyj) No Type OLW61y 1N11Vd- 13 Wage CcdFs <br /> I <br /> fY <br /> a <br /> r <br /> a <br /> w <br /> 2 <br /> U.1 <br /> C7 <br /> 13 S[t- Inkrrratxm <br /> rylr <br /> k � r <br /> I <br /> 1� *r:E a ATpR'5.'OFFERDR'5 CERTIFIGATIt]N:I hereby declare that the oxNeft of Ihls ecns prnw!are fatly and e:curarely desoted above by vie proper smpprrg nrne,and are classified,Packaged• <br /> .. 3n Iahele&piatarded,and are in as reqmcks in prom cordtlor for ter+epor,Dow FMng 19 uppkga6 a lntemetiorW and nubor i c,rernmental MgAglm.lNrr M ytrlpmant and I am the Primary <br /> terldylhal the contenl.5 01 Ws cansigrment cmb-at to ft tam of fieatledW EPAAftnuMedgment of CansenL <br /> '•7 r.ural V1e waste nwwraehan statanlenf Ider!tlied rn 4p f;FRR 262 271a1 i r t am a!orgy arra^.t,�nera'c+lar(by(if I am a Small qur�ty ger;erafsj s;true. <br /> r,. .• Afines Pnn*Tyyed Name q Tnature :+,6.•t_ Ua <br /> r J <br /> J lE .. �j'upnEntS <br /> i-- ❑"Pon>D u-S ❑Eryart from U.S. Port of ar y7evl <br /> z - <br /> Tf? mare lkx exports nn - <br /> — hl Data Ica r r.�t1 S <br /> a 17 T•, -VADMadgmenl of Recd;l of Mdterlais <br /> ul <br /> tro•.I 7Y a1.,re Month Day Year <br /> a <br /> un <br /> TraiS,ilex 2 PnrteifTyped Narne 7 re LIcrM Day Year <br /> :. •y Indlrat o n Spep9 l_J Type Re s•uue 1 i NAW Rejecbm, Fre�e ectlm <br /> Adertifrll Reference Mr-•,cr <br /> 15• •,r, Faa!dy(Or Gen~ U.5-EPA ID 11imber <br /> [a <br /> 3'!= ,!avx:rayferGerserasorl F,1on>h Day Yesr <br /> Q <br /> Z <br /> • � pod zagement Me7rod Codas ti e.,coder<fpr fte7ardaua wase uealn ant e.scasal and recydrrti]aysrarns) <br /> 2 4. <br /> 7] Cev: a=] ;-+ny Owrre►or Qperalcr CerldoW of recaps dhanMM meterWs covered by gra ma-dest except as Dow in Item 18a <br /> hn!ed :a a �na�a ttonlh Day Year <br /> EPAFtrmIRev 3.051 Prevrousedifionsare obsolete- G=ENERATOR'S INITIAL COPY <br />