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React:pr. I .r;rpe.(l-o---n designed lar use on elike412-p9ehk typewriter.) Form AWmed.(�fNf3 No.2050-W39 <br /> UNIF QRh!HA7ARDOUS '-T r 7.Page t o` 3.Emefgeney Response Phone 14,Wr—Tr�ck�q ute V1 JJWASTE MANIFEST �r1F t73 GJ. <br /> 5�,: _a;. s'+rr a<�hSa i Adcress mors 5l.e Address{It deferent them maihfg address} <br /> Tf7-i_-•--er 1 Company Marra us EPA 1)Nss W <br /> T Tra-,.---•7 Company Name U S.EPA I D Humber <br /> 7e;gr 3•=d Faalrty Name and SileAddress U S.EPA 0 Munbar <br /> F_-.,I :W-:.na <br /> o, J S DDT D%mpbon(odadmy Prnper Shipping Neale,Naavd Class,ID Number, 1f1.Cunlau er< <br /> 11 T013 12.Urit 13 W"te Codes <br /> No Type �N3' MIM- <br /> 1 <br /> ce <br /> 0 <br /> rq" <br /> LU <br /> 11.E <br /> 2 <br /> LU <br /> Q <br /> i <br /> 1.: G+ , -.ar.'r.•�InBuucbonsand Addl,7nal lrfnfnr3;cr <br /> 1 <br /> r <br /> 1- uENE YATOR'SMFFBWS CERTIFICATION:I hereby derkrre dtat the Codmis of this Cane.gnmxn:a•e Mly erd e:•_;ralpl f de-,u ted above by ftp"s*I>N mems.and am dusifrod•wi ages, <br /> *-,,::•and fabeledlpbcarded,and are in al respects in proper mr4lion far ua sport nw ting to applrcable rnterngligrral And national pavemmental mgtEtalm.If Asper;sh:Finaa!WWI am the f'nary <br /> L rxdr I cwtrfythat the Wnferlt5 ffift mrrsigrrnersl cordorm in the tomm bl theatmched FPAA mMAedgmenl W CWSEYIr. <br /> z t f.v at t tie xasla mei r¢ahan srstcrtrtYtr kden ed in CFR 2c2 27 a i`I am a large cCra?'.mrle•a'c•:or Ib]t f l Styr a small quantlty qer erdlor}is his. <br /> Ger*rar-ri Jfle�.X5 Pnnleoly*Name MorRh Day Yea[._ <br /> � 1E r ,_..at•_-al3rrprrrents <br /> i ❑ImpCrt'n U S. ❑EVO horr U S. Port d errbYAA <br /> T•..r rt>+•anature tkr e,Ws only} Daps ha':-7 U S.: <br /> 17 T-, > 3 rrdrov?ac[ enl ad Recapl of Mamdals <br /> Tr„i,r re]T}pBGlferne :rart,re Mdath Day Yea, <br /> O <br /> a <br /> rn <br /> QTra uer?PnrtWypWNan* Slgreture hlenth Day Year <br /> c:a,cy irdic0on Spam ❑ ❑ ❑Rd. ❑Nrtid Rejection ❑Ful R*.d. <br /> Mande:stltafamneeNU, .•er <br /> 19^ Rl'r• ]'•Fat'ay{orGeneratarl U.S.EPA ID dumber <br /> U <br /> II Fa- <br /> r: - I7rtern;te�aJlrly(orGereratanl Moth Day Year <br /> d <br /> 2 <br /> 19 -faza, �s Waste Repon maiigem-m metiod Codes li e.,codes for humdom na e t_.. _ d :syslerrsl <br /> 2 4. <br /> —7 1 <br /> 3: Dwir-1-1 F aciey Owmaror Operatcr CerhhtUa r of meipS of hwrdous,malerUs Cavorw Dy the rra-L:le5t except as ndad in Ilem laa <br /> hlon'h Day Year <br /> EPs=•. *,;iRev 3-051 Prevrausedlbonsareohsolele. GENERATOR'S INI71Al.COPY <br />