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P find or type. (Form designed for use on elite (12 -pitch) typewriter. <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />WASTE MANIFEST <br />6. Generate fs Name and Mailing Addrests $€ <br />z4? a4 iib l ) <br />7'r f 4 GM``�SC34� <br />l.Civil'},1 <br />Generator's Phone:+a,•1"; r,; ne- "`,/"C} 1,•r <br />6. Transpoder 1 Company Name ) ,e <br />7 Trans r:; 2 <br />Gr4'pa"'y��, <br />B.D�g�lFd; Satp(�y aar(d8rl9Adtlra%..: ��. <br />[yam KAY ROA!3 <br />VAGA�AI CA <br />Focht s Phone: it77111E416<76 <br />ga. 9b. U.S. DOT Descrbeflon (Including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (it my)) <br />17. <br />ierator's Site Addrre�s(s, <br />'G•1m MVI <br />(�t�1.V.G�fls <br />.ti <br />No. <br />ry IkI 24 106 <br />10. Countries U. TO 12. Unit <br />No, Type Quantity W1Nol. 13. Waste Codes <br />i:'srI FBF <br />�` ,:i`Ct5 Fe@ihr�VAL FF$ta !F"u?.4i�td1' d?3CFF,7;i (BR.tafiv$tS: fi+.EC9, � LA$E:Lk{;j t.'�Td�:S:'Sa .. <br />iRiR� ao tYYJS iSIHHU>N;a FA&F IFS. 01AE" iY79t T-9 M$ 5 �4. I:AFTML ATX, tA. xP.G�A-eY F?hJ: wof <br />GENERATOR'SfOFPEROR'S CERTIFICATION: thereby tlectare that the contents alibis consignment are fullyand accurately tlescnhed above by the propershlpping name, and are classified, package <br />marked and labeled/placarded, and are in all respects in proper condi0an for lranspod according to applicable International and national govemmemal regulations. If export shipment and I am the Primary <br />Exporter, I certity that the contents of this consignment contain to the terms of the attached EPAAckmavedgment of Consent <br />cedlly that the waste minimization statement Identified in 40 CFR 261 pf I am a large quantity generator) or (b) (it l am a small quantity generator) Is true. <br />ators/Oderofs Primedlfyped Name SlgoaWre <br />s <br />♦ a=�•Z hlonlh Dey <br />tem conal Shipments J'' <br />. ❑ Import to U.S. ❑ Exced horn u s and „r e�ift,re.n. <br />r, <br />Date leaving U.S.: <br />.p 18. D crepancY � - <br />I 18a Discrepancy lndicalion Space <br />❑ Duan(ity ❑Type ❑Residue ❑ Partial Rejection <br />u: Fadlirys Phone: <br />F10o. Signature ofAltemate Fauldy (or Generator) <br />d <br />Go <br />19. Hazardous Waste Roped Management Method Ca <br />1. 2, <br />20. Designated Facility 0 m ror Operator: Certification <br />Pdnledlfyped Name r <br />EPA Form 870022 (Rev. J-05) Previous editions are <br />codas forhazardous waste Ireabnenl, disposal, and recycling systems) <br />3. 4. <br />(of hazardous materials covered by the manlfesl except as noted in Item the <br />t Signature �. <br />Foil Rejection <br />