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cvPlease plintor type.(Fotm designed for use on elb(I 2-�ftch)t9a ----- I I '��/ed.0)2BNo.AM039 <br /> UNIFORM HAZARDOUS - 2.Poplof 3.Emergency Resporm NumW <br /> WASTE MMIFWT CAI-000i8264V- I i I -�gooj 4-z4-93ul 010)M85959 JJK <br /> br.Genet&rt Narne and kWing Address om audro3s) <br /> s PF� B-BE�.'2 2 2 2 <br /> 500 E--KE—MLE,';A�,N R. D. <br /> Gonerawsmone: <br /> 6.TransporW 1 Company Name U.S.EPA ID Nwrbef <br /> C'A E)0—2 13 2-7 7-0 3 9 <br /> Y EMU "N-ENT"'L, <br /> ASBRUfR MCIf-K <br /> 7.Transporter 2 Gompany Name US.EPA ID Robw <br /> 8.5;;�nated Ndk Name and Site US.EPAU)Numba <br /> SiEMENS IMMSTRY,NC. <br /> 5 S'771',-qO TJ*r-H n�O Y;L i�A v V 4 <br /> 5 <br /> 12-U it <br /> 9b.WIS.DOT Docrili'm(hcW&V NDW.PliWA9 Name.hazard Cass,ID Numbe; 10. Vr 13.Waste-G�des <br /> mM TWS QUanty t 'at <br /> 352 <br /> t <br /> SOLID(CHLY 3GLDFj <br /> 2- <br /> V L.LL <br /> 4. E+WiRQWMEUTALHEALT-H .---- <br /> DEPARTMENT <br /> 14.Spa"FlandrM Instruc5ora and Addtkival jnfixrr� Ro 1-#eA-:L.AftG:7521049 01Y <br /> EMO�WENCY CONTACT:Uri EM-1 P E0 NAERG#BB± M. FL' <br /> M- PRV— '-r--L I 'I"—- I-R.IAEMT /'_1 <br /> ,N!Dg- APPRL 1f:PEFM4A 9RGT;rT-�r - / vl'7 7 <br /> I hereby declare LW,the CMLMb Of OTIS Wrti!Gnmerq&a fik arsd=mtoty tiaw�abym Ity ffis MW 10M MIM,Bt am 05ded.PackagW, <br /> 15. GENMIAMMOFFOOFUS MMMATION rMuonal wvwrorw�w rolp&bnz.If Wort-.Wpmont and I=the Pfirnary <br /> tabjedjpWMrd6d,and am M all mpa=in pmW cDndVw foTtran"acwrdirig to aPPl1tab4a,inUmiabonal <br /> flme,lt Mlorm tu ft term cl the oftched EPAAdu�Medqmontt of CwwenL <br /> I MM 11181 ft Gotem of us vuro-9 <br /> ?Ao th Day <br /> Wan <br /> -1 %International SUpments pod <br /> i;- El EW from U.S. <br /> oniy)� <br /> ='17.Transpmer AciTwiledgn-tOnt Of Rsca!Pt Of M&ffials, <br /> Trarmspqftr I PrI pe'd Nam <br /> on!� � .2 Mmth Day Yew <br /> W1-- —65a�l- <br /> Mc a,&06ftr 2 Fldntedffyped Name <br /> .�c <br /> Realdue NOW R*cbw R11 Rev,-aon <br /> t8a.Disaq=-,y tndicabor SP-ace L1 Qua-lbly Tyw-, <br /> U.S.&A U NUMur <br /> ILL FadHO Phone: MMth UAY Y02r <br /> ablity <br /> 1&:s4ron of <br /> ID om waste tualmml. and MOY61ng Wtwm) <br /> 1 S.Hazard=WaVr i drt rhA 3. 4. <br /> 7- <br /> by ft rnan�est excW as rdad In Item 18a <br /> MD111h C*Y YeS <br /> Ut <br /> EPA Form 8700-22(Rev.3-05) PreAous editibm M DMILte- DESIGNATED FACILITY TO DESTINATION STATE(IF REQ RED <br />