|
'.i: r.. �.: ;.,I7,--"---:, •y.., ws;•.i'-.
<br /> S:'. .
<br /> n u
<br /> ,1. ,u.y I
<br /> Please pript or types :y �tf ''. E orm Approved:-O,Mp No 2g5a-0039•:"
<br /> `1. UNIFORCIM FJA`LARDOU '1:Generator ID Number r 2 a�o,1 of 3;Eri}ergeh1.cy Response Pfi4ne' 4 Marilfest•Trackirlg'Nu(m�bef,• .,
<br /> NIASTE MANIFEST I. �'®b � 7i 1i1(t W :tr. : 1 .,EP
<br /> ti,Gerjerafor's Noble and ling: dress- «' y" >` Gghbrafofs IteAddressl{if Uiffer9nt thani.mafOng adtlress}' :;'
<br /> g�+�.qyqrr , � ``y �>,®k r�, Ti.a. 't! ::tiyi� �t .. .I.lrrkcL...,I 3�! x.e.
<br /> ' .IST( Ts"v,,�k8 R`. �. •. - .. . ''t;': ..1.'. 111 ��Ir.' i,.SW.....: i'Vlr [ 14• % f
<br /> a `,:t.. ..i' :r... .:1 .4 I
<br /> Gen '1'o'sFh ne rJ � ti; ::
<br /> ., i.
<br /> `,::
<br /> 6'Trans o Co 'a e' :i U
<br /> rter m N' '•,: Si EPA o b
<br /> P.. P.by a 1,;; I`i(•:'! ;;•°`r`.i.,. r. D. .m...fit. i'
<br /> ! 1 „>.
<br /> 1,'S.r rr,,' =i.i
<br /> h'''S: ,. l'1'r.'
<br /> c 7:Ttansporter,2 Comp�rty NaIn tt.5:EPA ID Number
<br /> r, l. I
<br /> e.Designdted: acili(y Name and SI e,Addtess i'c Urt u,$:RPA'I Numbet. 'Ir
<br /> Ic
<br /> 1.
<br /> ` .; V°'�'� 2 4 ... ,t,.. , .til 1 ,�1
<br /> FacllltysPhone: :r. ,1.v 7•:,
<br /> �Y. :�•:-
<br /> :.
<br /> i: ;i:.
<br /> 9 .U S:'''OT Desbd bo IriCI'`f'Pr S a'e:'H ze'rd'Class D ' Co ai''8"'' f
<br /> ga. b p n( eluding' pet, hip i. m a I N-,*?"; ' 1b. rIt r}"sI 11,'Ttati 12 U'I[: I
<br /> .�. . 4 ,,,;' ...n.,..
<br /> and P ckfn GYbiip.`lf:anY ';r;13 W:..;¢�eai..
<br /> HM p, ( ))" Nd.':' ,`Ty e°' Quantify Wf:Nol:
<br /> b 4'T� 03-i!#+ 111q t l'w 4�i Cl j #!-. ( %T ,;,1•:.;. ::i's• I : 's .: u7�1
<br /> ,d IA r r I'll t L + 1• 11 t' 1 I i ,, r i '4 1 i', f •�...+._,.
<br /> y l Irl r. 7 1 {t„. ' I a '�
<br /> .. ` .r' f l!::; ! :i'': ilia+
<br /> .
<br /> 'LU
<br /> l-i
<br /> .7 11
<br /> f �!r :tl r:a,r ,.} .;.; :,i ,•,..j�-,{.r. Y r `, .;}��t} .I q. I ,:4n}rt t..;t. i•d'. ?
<br /> .. ; I t✓,,i:7,' .. ::kt3. - t i,ij':..1. .' tit k git,ttI. I'7
<br /> . : :'.
<br /> .: .
<br /> I
<br /> ^i F:
<br /> .Y. '1 �'I.:.
<br /> 1..
<br /> �'
<br /> �R.r P
<br /> ,r 1. :t
<br /> i'i`
<br /> ,1.1 .,Y,,. t..t: .'i,tf: y 1. V,;'- r,.- .it?• �.. 1.
<br /> jj�g'k:•:. i
<br /> I
<br /> 3.
<br /> k-
<br /> c` I
<br /> I f•.: :d 'i.' 7
<br /> I
<br /> ;','•:
<br /> F-: i
<br /> 4 1
<br /> 14.$p'ecial Handling Instruction's and AddiUopfif.lnfdmiation Ill 1.I.
<br /> ,'.
<br /> t
<br /> � *--*!.t�, . I ^i,:..7,-��-..."" ". 1: , W,W` .., . �:: I . � 1.� :,
<br /> •t.
<br /> ,).'
<br /> l+
<br /> tr
<br /> ,'; -� •,'
<br /> 15..,'GENERA TOR'SIOFFERpR'$CERTIFIC/{TfONt i'hareby declare ttiaYthe CliptatSt, I this cdpsign n(rare'sully�nd aC u}&.. .1.scribed-db0 b>'',tXa propi3h�hjp¢Irig,came,aril are''plas$Ifled,pecKaged;•; i `
<br /> rttiarked and labeled/placarded and are9n`ail respects in proper condition foi1fprjpport apcordin�tgappllcI . InternahonaJan,.halionatgoyernmentai regula{ions jf ezport,shipmen('apd'I a'rd tfi, Pr(Mary '.
<br /> Ezportes,'I'4erUfythat.thecontentsgfilhi�;�gn�igptnentcarjfopm;totheterin:of{hg; jtlOfte�lFpAAeknowl4g'rpent;ofCtinsegtn ' ;;'y,•;, '•''t
<br /> I cedify,th'af the waste',minimliation slatergert0 entifie -16 40 CFR 262:27 0 li;I arh Idr uant ry eneratof;qr ,i' a:rfia(I I. "uantl 'a pratbr Ig,true,:• ;z:;.::.r
<br /> f).(. 9.P4 g. ,) t 0?, e_ fl. ..fig.,(!. ,.)
<br /> G@rte•afslOfferor g Ponted/)yped Name•, siffnatute t !,f'
<br /> :;
<br /> l
<br /> 16.Intemational Shl mems ^/
<br /> P
<br /> e.
<br /> }E' Part'ot ant /xit
<br /> ;F— ..Import to U,S.' xport from ll S ry.
<br /> Trans orter sl nal re forax ' o I .r<. : : i s Date leabin '.0. . .'i°t• f:`:r' i
<br /> P 9. U. ( f�.�t rl y) :j t 9. ;,.,y 17:i'
<br /> t7•Trari '81r rAckn edgment.of ftgcelp(.of Materials' 'i t':,,;. . :.. ,c:, 1,:.:.,'
<br /> a,Transporter 1 ni,tetlff1-1 yped Mame j $fgnature {{I ;i' A�onth rR�ay Year.
<br /> 1. 0 4 tt \, 4 <r', ;i' I� :'11,E' I. . �F
<br /> Transpor(et. Pnntedl)ypad NameI. S gnatpee' Mo'hth :Day Year
<br /> ;'',' I :i i:l: ;,1',
<br /> 18:bis'rePaficY f' ,. 11 1
<br /> 18a Discr9partdy Irid(catloh Space !,I j', '' ;r
<br /> 1: D.Quantity, O Type i.,. ❑ResldUe PartlalBejecilon' I. •�Fu11 RejeCUon
<br /> �iS ., •t
<br /> �: r.I: r,: .. „
<br /> i.
<br /> a'e§'
<br /> M mf t efe a u. er..'
<br /> R eN
<br /> rt'b
<br /> 18b AI('g?nate.F Ilty(or 66helator :i•• :: U S EpA IR'Number'
<br /> „ ''"' ,:
<br /> ,Ql. F ,: ;+
<br /> I y�G 164 Signature Of Alternate Faality or Generator) .iiI. Month bay year
<br /> ,
<br /> t.
<br /> n a r ,
<br /> 18.!a34ous Waste Raporl Managjmejtt A�elfrod Coda's(i e„codes(or hazardous wagle trealmeni disposal and recycling systems) ' f h, I
<br /> 0 bass n ted F II t or,O r�atorf Ce fication of recal t`f ,1 arrlo"s niaterials wVefed 1';t e' ni esf ekce 'as dad I Item'
<br /> ;i7;. s a ac ypwner. I , 4 to P u. pY. m 1 P( n
<br /> .,i I ��6 ,
<br /> I " ' rintedgT ped.Name 9lgnature , f ottlh Day Yea(:
<br /> rr e y
<br /> . % orm 8700 22(Rey 1217 Previous editions'are'o soja#e ?:,'' NSPORTER COpY`
<br /> ,;`.�,
<br /> s t. i .. }; l , r
<br /> V' 1 `t , i; .'� f .1'. , 1 'a slit
<br /> h-
<br /> S1 x,<.:
<br /> 'I'
<br /> :;.
<br /> G ji'' G
<br /> i' .,.;,
<br /> is
<br /> h" Y
<br /> } �.:
<br /> t.i
<br /> J4' l
<br /> 1 �t
<br /> 1 1
<br /> s '.�•,4• �r�r,_..�r.e+::r_,� �.a%`� .,s.ii:ItL',4.:.u, x :?;`�,�:.1^, !:;.6,..+�1.. .rte'-;:..t:.::�':�y'-.�_..��.. _.._�„�.�% ��,__. S.a::a'��.:d_:}tc.._.::_.�.. :S:-.:..�._:,t,..
<br />
|