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v .OMB No.2i15U-0t?s9 <br /> Please print or type- Form Repro ed <br /> UNIFORM HAZARDOUS 1 Generator ID Numt er 2.Page 1 of Emergency Response Pkwne 4.Man fest Tra/c��kin NumbQer //{{ C f C <br /> WASTE MANIFEST t 11 1- � ."t�2$9`'tl f LC <br /> 5.Generators Name mA Maoi g Address Genofatoes Site Address(if different than mattiro addrass) <br /> t-sY-.0 <br /> Gerrerators P:,one: y.. <br /> e.Transposer 1 Company Name U.S.EPA ID Number <br /> 7.Translw.er 2 Company Name U S.EPA iD Number <br /> 8.Designated Fo(�lity Nafr+e and Sit,Address= _ V t _ U.S.EPA ID Numtxer <br /> -2730 <br /> �... �. ",Eur 3s-r.43—I-j2 <br /> F�lily=Pbcrte j <br /> 9a. gb.U.S.DDT DescripWn(midtvJing Preper 5ftiWnq Name,Hazard Cknss,iD Num be', 10.Containors 14.Tctai 12.Unit 13.Nasty Codes <br /> HM and Packing Gtoup iif any)) No. Type QuanSty 74t Nof <br /> € r -1115 P 3 T <br /> of <br /> 4 I <br /> Z 2 <br /> w <br /> 3. <br /> 4. <br /> 14 Siap Handkry Instar tons orf!AddifWd Informatics <br /> pec <br /> WJZ:) }QD� <br /> 15. GENERATOWWOFFEROR'S CERTIFICATION:I hereby deciare that t*cortenta of this crsignment are fully and aceinateN above by the proper sN name,and are classtWd,packaged. <br /> marked and labetedlplaca ded,and are in all respads In proper wrtditon fa transport according to applicable t-matonaland na' govemmentai regulations.Hexport shipment and I am he Primary <br /> Exporter,I certfy that the consents of phis consignment conform to the terms at the ahachea EPAAcknowted of GxseM. <br /> I cert y that to waste irsnim¢at`.lon statement identified in 40 CFR 262.27(a)(41 am a targe qua^Liy gertef ) sell)(111 am I - ltty generator)is true <br /> C-qne M D t L� v t Day Year <br /> ratdsi0tercr`si'rinf�7fyped Name„��}-'�- #- <br /> M �1 / <br /> 1 t&.hrterirat ono!Sh nt5 ElImport to U.S. ❑EX{9r fmm U.S. Port d bytext: <br /> z avugl S. <br /> Transporter signature(for UW3 only): <br /> of 17.Transporter A ktm&ddgrwilt of R,-Wpt O MaWals <br /> LU <br /> Transporter 1 PrinredlTyped Name hypos( Month Day Year <br /> OCL irx4w�- <br /> g Transp>oder•2 Printed Typed Nam, S' woe Mcnih Day Yat <br /> r <br /> le.Dixrepanq _ - <br /> 18a.Discrepancy indication Space ID Quantty J Type ❑Residue ❑Parw Rejection Rill Rejeclian <br /> Manifest Re#---Numbed <br /> H 18b.Alternate Facility(of Generator) U.S.EPA ID Number <br /> U- F-aciti sPh,one: - r``rni, Day Year <br /> 18c.Sx na'ure of Aitemate FwAity(or Gemratof) <br /> LLI <br /> a � <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,&posal,and recycling systems) <br /> w 1 2. 3. <br /> O f j <br /> l_/i1 I <br /> 2G.Dasigrate Fac lily Owner or Qperatar.Cer'jfca^n of rocGipt ofhaaedaUs tratar aLs covered by the man fest axanpp ms ndad in Item 18a <br /> Phritedr pe ti .e _ = SQ,alure MonCn -Day year <br /> 4 � <br /> EPA Farm 87G0-2(Rev.12.17) Previous editions are obsolete. dE # A FAC{LITY TO EPA's a MANIFEST SYSTEM <br />