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Please prn,a,f;Ae ff'orm designed for use on elle(12-Mch)lypewriter.y Fo mAppmved.DMB No.2054-0039 <br /> UNIFORM HA7ARDOt1S f-em6 r in liufhher 2.Pap 1 of 3.Erne pM ReapD m Phm+e 4.M.aVW Tracking Number <br /> WASTE fdANIFEST '� � JJ <br /> 1 5—GE-rz:r< Name and.1a:,:r3Address Generalce-65r*AddnM[if dferentthNmailingaddress; <br /> rr..a., iiw km2 - 21041 Imo* lr <br /> le" BE. <br /> Generatarsllfate 530 31e--5179 <br /> h <br /> 7rar15yrer 1 U.S.EPA ID Number <br /> tin 060"emT 0"biiml Inc '9k/1756" <br /> Tra•,p..1er;C:cnrWrry Name U S.EPA ID Number <br /> $4esgnemdFaGdrt"Y eas 36P4dtU.SgraMlalbw <br /> �Arth Aamooft xt�t <br /> rft 992= <br /> aa. 9b V.S.DOT De-"-[indudfng Pnkper S*ping Name,Haaerd Class,IV Numb'-. 10.CEn1i11Rtti TaW M WIN 13 Waste Cases <br /> HM a-d Padding Group T any)) No. Type [�uw" WLNd <br /> >dlgl I <br /> w — <br /> Uj <br /> z <br /> THIS WAM STIP HAS BEFQREN af,nlaFIFn <br /> rAENNO,fcERCOpN D8A WORLD OIL <br /> 1RECYCLING FAC}LfTY W COMPT0N.CAI lI OFINIA. <br /> T}{(,FACILITY HAS THE NECESSARY PERt.c <br /> fdTs Tn <br /> OUR LPA 1+kUMBER iS CATWM13M ALIFLD <br /> 14 5F -r„ `4and6Mln5lrVC4C-ft andAddrb"lyd4nn85M r <br /> to 1 BbW ftGPW TM CL0tkLng; •s 'l: anrr4 or awwwgMowly emat int Cwt' <br /> '_" inyiat Mt #C=974ia*, VOW,; " CAP <br /> 14. GE NERATOR'S'OFFE ROR•S CERTIFICATION: i hereby dedam t!et tfla c ftrits of the cartsTme M are k4 arrd awiraleiy descr tred above by the prcper oh pp same,art are cars-fea,Packaged. <br /> masked and Iahuledfplacarded.and are irk all mpe&In pmpercondddon far 4ansporl eocarding to applirahle inteffebonaf and nabonsl gwr miirrlfal regulations-"expo[!Shipmenl and l am tha Drunary <br /> Expoft.I oertlty that Ore contents of 0111 aymomed conform b the tam o1 to affachad EPA Aciurowladpment d Cpnsmlf. <br /> certdy coat ft+tea mrftk9 o andemeril IdrnV*d in 40 CFR 262.2 7:a r'am a faW R:anv'a geresstcr c = am a small%anft gera <br /> Gcner.s!:i_::+11ez5Prx�:ed?yped Name Month flay <br /> .J XIr:tcrr.at:cnal Shiprwu ❑ <br /> kw I V S. ❑E='Vw fvm U.S. Port of enhyfa . <br /> Tramp_nwignawrellcrexporkp*� r7ate-a. us.: <br /> w 17 TramswwrAcdmawledgmonfPwdptpflrldeYq�s <br /> w Tran epcierI PrprladlTypadNarm S:7-a yrs Mooch Day yea. <br /> cr. <br /> rn <br /> C Transpaner2 Rnrnedrr,,pe0 Name Srgnawre Mcntr i73'f Yeti <br /> f- <br /> 10 a rep3mry <br /> 18] Discrepancy khdcalan$pate Ty" —Residue ❑Psw Rgad!an Ful Rejection <br /> Manifest Reference Numher <br /> 183.Acte••_.�Fatty(o•Gerierdod V.S.EPA It)Number <br /> J_ <br /> !.7 <br /> W Fadrl's Phyla. <br /> yaj 1EC S•1raj1 a olAlto.matra Fadkty[orGenemior <br /> 4 <br /> RepafAaaementAagCodes(iia.,redY;!or ha:ar&uiaas 6 treat mmi d sFasa`.ardrecyding sysle'ns <br /> 3 4. <br /> 2t].oe s ynated Facibry Ow er rx operahor,Cer"Xffillon 01 MOW r!f haxardahrs M le^aft cpve•e:;.the manifest ekcep'as r1--d in Ilem 18a <br /> Puled rg-M Naive Signa}.lie -.'h Day Year <br /> EPA Form 9100-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />