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<br /> FUNIFORM HAZARDOUS 6 r";€ blots ! eS ;i + ' ' g . t tai ;ol b ,O Y 2' )k A °a ' •'
<br /> WASTE MANIFEST " ,J."" ' led aTI k � d m ,� SKS
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<br /> . 7. Transpoder2 Company Name - U.S. EPA ID Number
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<br /> ea 96. U.S. DOT Description (including Proper Shipping Name, Hazard Glass, ID Number,, - 10. Containers 11 .Total - 12. Unit
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<br /> Specal Handlinginstructions and Additional nformation . . ,�, -
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<br /> 15:� GENERATOR'SIOFFEROR'S CERTIFICATION: [ hereby declare that the contents of this consignment are fully and accurately described above by the-proper-eh[pping name, are are classified, packaged
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<br /> Exporter, Pcerifythat thcontents- of consignment on form to the term Fth at(acheq EPAAcknowledgm � fC nsent -
<br /> Icertifythatthewat minimization statement identfed in 40 CFR 262.27(a) (if lam al arge qua
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<br /> 17. Transporter Acknowledgment of Receipt of Materialsat
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<br /> 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Hem �So - � _
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<br /> EPA FofT 870022 (ReLLav 3"Flo-05) Prellous editions arelobsolete ,r DESa�rei€dATED FACILITY TO GgigIERATOR -
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