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Please pr r( -•l;pa„(Form de5igned for use on elite{T2-och)typewriterj Form Approved.ONO No.2 50-0039 <br /> UNIFORM HAZARDOUS 1 T•Generfrmr ID fJjrrter 3,page l yr 3.Emergen:y Respanseftne 1.ManNestTrawng Number V <br /> WASTE MANIFEST "� I 1 I[` <br /> �. f Jame and A1aling Address Generator's Site Address id d P.erent than ns WM qd&M) �1 rl <br /> G(-, --_ne <br /> 5.T., 7'Company Naufe U S.EPA II)Number <br /> TranW.rb'2 Campany Name U.S.EPA ID <br /> 8 Des-3ep'edFatddy Name artdSilo Address u5 EPA117t4�-ter <br /> i <br /> ga U.S.DOT pbon{rrdudin9 Prom sNpp�g mare,Harxd C1sss 10 Humor. i o.Comarkrs <br /> I tt q Padang Grp ila^1')l No TY1?e QtiaTil4*OW 1kt1Vd 1'1 Waste Codes <br /> c� <br /> v <br /> a <br /> s <br /> w <br /> Y <br /> w <br /> ra <br /> 1.1 Soeo3'haldaN Instrr�tans andAdddional 11dwatko <br /> r <br /> 15 GENFRATOR'9f0FFEROR'S CERTIFICATION:r hereby dome Thal the axAmMs of fhia oonsgnmsnl arc Lely and acunmry dDKnbbd above by the proper ahpptrlg narre,aro are dassrfies.pais:: <br /> nal,LG and Iabetedlplacarded.and err in aM raspects in piper wed119an for transport aacordlng 10 applicable intomafianal Wid rreaonal governmental uW ons.11 expad <br /> xarler.I cethat the conimu of n+s psr*wnent coobinfb the to m of the attached EFAAcknawledgrrrem❑l GM56 it sh 1°m end f am Ire❑r <br /> rtify .r} <br /> csrUy fleal the waste rrinhrfltat=aralen>ertt klenr Sadie 40 M252-27(a)l f I am a large c63*,GerE[a:or or n I am a miail q;rardtiy gerwatc-)s h*. <br /> Gene-ar3.1s,Olfercrs PrmedTypedNam@ Swalure Mono Day Year <br /> 15,Intemik:nal SNpment!i <br /> ❑WVMbU$. Export f,,U.S Fatofenbyew <br /> Tran%.;r.;•,y^afore(for ei-%onN) Owe wyrngUS.- <br /> 17 <br /> S.-i7.Yr}r,.;r*Acbm0edgmem of Remfpl of Maleri* <br /> aTran5pona•'Pnnt-M fy a^`+drne Signal= Month Day Year <br /> IL <br /> Tran-...ter 2 Pnnted ype %&w Sgnawm Mon&,, Day +-a• <br /> 18a-Disaeprn y Irdicalion Spam ❑ y ❑Ty. ❑Residue L PA rnal Raja ElFwi Firjecbon <br /> Marifesl Reference Njrmber. <br /> 19a Anemate FaMy(or[ienwalo) Eat,!['Number <br /> V <br /> U' Fav c;-ohms: <br /> W ofAhemateFaokty(or Generawr Fkdlth Day Year <br /> a <br /> x <br /> � 18 Haz8fdbus Wasie RepxMaerrenl MG&Qd Cas <br /> s,cedes for hazardoc,s+.a.1e o-aalrlfent::Fc53',and reryJ,rg systems) <br /> 7- 1 2- --.-T 4L <br /> 20 C6 'ted Farily Ownw or ClWetar.Cerhfat,on of receipt cr hazardous leebrOls Covered tj NB•-:amfee:errcep'as nded In Item 13a <br /> Fr rteil -7 S.gnatura 1.1--, Day Year <br /> EPA Fora 870-22 rRev.3451 Previous ed:tions are obsotele. GENERATOR'S INITIAL COPY <br />