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r: or type. (Form designed for use <br />UNIFORMHAZARDOUS 1.G�eneratm <br />WASTE MANIFEST <br />facihlys Phone _ <br />_„_.,-..;It1 <br />9a. 9b. U.S. DOT Descdplion (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (If any)) <br />No. <br />aA <br />10. Contalners 11. Total 12, Unit <br />No. _ Type <br />Goan <br />WINol 13. Waste Codes <br />6Ad f <br />• 6�, --- !,- '-fir^ <br />I r' <br />she Nat <br />AdKQ, <br />4. Special Handling lnsWcimns andAddrtronai lnfonnalion <br />1460 <br />GENERA70R'SIOFFEROR SCERTIFICATION. (hereby declare lhail econienls of this co signmem are fully ands curaterydesc Letl above by the proper shipping name, and are classified, Packaged, <br />marked and labeled/placarUed, and area all vesper,is In proper condition fonranepod according toapplicable inlamallonal and national governmemsl regulations. Ifexpod shipment and I am the Primary <br />Expoder, I cedify Thal the contents of (his consignment conform to the terms of the attached EPAAcknovrledgment o(Consenl. <br />Iffs Iherm's waste minlmizallon statement itlenlitied In 40 CFR 262.27(a)(iflamalargequantity generator)or(b)Pflam a small quanlitykenerator)Is true. <br />am IorslO eror's PnnledNyped Name <br />n t ���igna are <br />rb. �s',+ on ay <br />Ince auronal Slpmemstj �7 <br />❑Import to U.S. ❑Export from US. Pod of enl /exit_ <br />�spoder signature qor exlwrls onNl:' ry <br />17 <br />18. Discrepancy <br />1Sa Discrepanpy Indication Space ^^ <br />❑ Quantity <br />20. Designated Facility Ormer or Operator. <br />PrintedAyped Ngme <br />editions <br />Type ❑Residue <br />codes for <br />hazardous matedals <br />Rejecgon . ❑Full Rejection _ <br />D Numher <br />Month Day Year <br />