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Flea;::Y,.r._' i Farm designed for use on elite(12-pith)typewriter.) Form Appmved.OMB Na.2OW-DD39 <br /> UNIFORM HAZARDOUS t Gerxrator ID Number 2.Page 1 cf 3.Emergency Reepmse Phare 4 Man fest Tracking Number <br /> WASTE MAMIFW U U G J J K <br /> Naw!and h+a,ing Address Generators 5 e Address(d dileient than mling addresst <br /> 2041 NavN Dt <br /> . i3: <br /> . ht ri h <br /> r,iit <br /> Crmpar y Fume U.S.EPA ID Num T <br /> �t S - <br /> ;,tPCr C,2 Ccmpony Name U.S.EPA ID Number <br /> Crated Way Name and Sste Address US EPA Z*mbar <br /> F. •'r 5 Pnyw <br /> ga % US DM Dasuipoon 0rdUr:WN Proper Sfgppirtg Name,Hazard Class ID Number, 1C.Contalrrets 11.TOW 12.UrA <br /> rhi <br /> Nk1 anti Paig Group fl any)) 13.yYesia Godes <br /> No Type Or�ht;x *UV(* <br /> t <br /> �u <br /> PAS [i w6erclous ■east;- ,T xCrr i <br /> S7 r.}•r►.k <br /> and O bt1sI 7f^1 r] y <br /> S C <br /> 14 >:... - :andhng Irsrn cLcns andAddltonih krfsuniAen <br /> Wo t- sY r w=Opei 11 EN(7T COWTACT C1'TWTRF <br /> 15 GENE RATOR'S10PFEROR'S CERTIFICATION:I hereby dedarc that are contents or this cansrgrrment are fury and accurahel 4vAribed eboxe by the omwshippig mire.and are doss f ed,pa-k,3t i <br /> rnerxed and lebelmWacarded.and are n ai respeda In PioW candltlon for Yamport amcrdng Fri aocaok interna ernmenlal ukkAs-✓sex <br /> �d�ro�rw 9e'� �9 Nrt atdprnarN and f am the°jyra'Y <br /> EKPerer.I COrGIy that the conkvm of Ir.<",;i_:gr+ra•rht mnfcm fo the to m d the~ed EPAAc1 r;a1 eb;ment n'Cariaerd. <br /> :e'16 tnt tree MS a rn MM20on slatetrreht!denldied h 4O CFR 262 27(al id I am a large gaant ty generatory c•.r 'I a>ya smaa Guant,.y yBr trocar,rs true_ <br /> General•-s:*FursN i,:wmName Srgnmure -r.th Da; Year <br /> J 1 ntena�9cnal5hipnrant5 <br /> �— ❑WPNI to tf.5. ❑Ergrnd traria U,& Portof entryov t:- <br /> Transr sem':gnakae I!a exports arty}. Dale IsasMtg U.S.: <br /> i-, rr::,LJ <br /> .:rnr AprosLfedgrr Of 1>t IAalerials <br /> rrans . Z�rihledrrypedName .gnat,de trtgnCt Day Year <br /> D <br /> M. <br /> za Tra isr-;rt=r 2 PnNedfTyyed lima Srgroure Ma* Dar Year <br /> Cc <br /> 18 Drsy-�s3ti:y <br /> 183 Di saepanuy Wcaton Spate ❑ � ❑T70 I_I Resdue ❑Panel Rt*b,,, ❑Fid%.ton <br /> lab.Av,, S3mFadrty(or C,eneraW U.S.EPA ID Number <br /> J <br /> V <br /> Fa 'ala .Pmrrte <br /> Month Day Year <br /> a <br /> x <br /> U <br /> 14 N3a rdCus rase Re:art ManagementMeM Coda f.e.,�-,DCez for heaaOmwaste treatment msec_ .azi re:,-:,rj s '•T <br /> LJ <br /> 26.fae_rnated Fad6ty❑vmcr a Operbr Cerh-firallon d re�ipl ui huardnus n+a'a:_-:nverQd:r the rnarefE,t encu;:a5 nrtsd rr Iteon t� <br /> Pani r.-r 7,pe i NaW <br /> EPA Fart 8700.22(Rev 3.05) Previoused itOns are h :'r,TE. DESIGNATED FACILITY TO GENERATOR <br />