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Please o:Int o type (Four: deS fled for u5e on ekrte 12- 14 GENERATOR • I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />ZetrjrrZ 1 ii51,..‘ 2 p ,,,,f 3 Ff""9°ncY ResPcn" Ph°" <br />e2-61 ° Kfideir) <br />r u; r i . inpulUTCPU lfiefICI M. .0.1.)-UU30 <br />4. Manifest Tracking Number <br />0 0 3 6 2 3 3 7 6 G B F , ,,-„.,„,,„,,,,,,,„,,,,, Matirg Aradress 6 ye) <br />Po fiA oittittio3 - It/6 <br />Generata's Phone ID <br />0 ..17403 iv eiv Addams lit deferent Chan mating aedreisal <br />57. -1 z 1 / 7,3 -niky, 6 4- 2.6769%) I <br />any Name . 0:I I Comp <br />'Is-BIAID'&1** <br /> <br />Ekilla-AJOAtinit 5"01 4' ite l <br />V <br />060V,21isef 3 7 Transporter 2 Company Name U S. ID Plumber <br />AlLakb 611411 iCONMINTAL ISOLUIR1141h I C "tabbb2.4152.1.40 <br />8 Designate Facer/ Name aril See Address US. EPA ID Number <br />egirg I otoNsmeNTAL %eau SakrIlow • Mt- • 3%15 /N0W97RIAL L. P1/4.21tb(305ZCA1e PikiLtril Sun% ft, 2. eis3/4 Li Faci4' s Phu* 1 I <br />gd 9b_ US. DOT Deeadason (rickaferg Pripet Shaming Name Hazard Claw ID Number. 10 Containers H Total 12, Und Ai and Packing Group lif any)) No toe away MA101 13 Waste Codes <br />1 4) Oki it ei4 1 4ra-4-0015 tili st9re WV/A 5-45 <br />1 4W, <br />ZZ/ <br />-------'-----'— <br />0 I6 /414---Z7(' 0 'A\ -.el <br />e4 iln-mitodo <br />5-,/ rp 11054012 1 0i0e-( ., <br />4 <br />14 %mai Handirg Intalactione end AO:NW& Wormatian <br />1 ) eilf ").1 C)°‘ 2 ) e V‘i6 t Ul 1° <br />15 GENERATORWOFFEROWS CERTIFICATION: I hereby declare dial the =tents of Ihs consignment am funy ard a:csatiny described atom thy Me proper snipping name, ard ate classified paz.kapea, <br />/Nuked and tabeiedinplaceideri. and are in al respect in cooper condition Iv candor, aoccecing sa appicatie 141l6Makin RI and ranional draverarnental regletions it expon shipment and I am me Pernary <br />Exporter, I certify het the contents of Ms partigniners Paton lo Me lenres of che adactied EPA Acknamedgment of CANIIVIL <br />I 4X4414y VIM the waste rrawiniatine statement tweeted In 40 CFR 2132.27(11 01 in a 1845e QUArity genorabil or lb; pfl are.raree _...Deelt.tree moo is true <br />i-m eieix"ProlitchlyZarief 45/./Aleizii. Sgrialure Mown Day Year <br />I 911 12k r 13 <br />t <br />ational Stureeres LI legal to U.S 111 Espial from U.S Part of antheent <br />Transmiruir isolate* Ila ego& amyl Dale leaving U.S <br />17. Transpatler Adinoseidgmess of Recap( cf Magmata _ <br />re <br />0 0. 3 <br />r <br />Skraftlfe 1kirith Day Year Trier: innmiedffrall NIBMIB zy/A09 <br />I 1 I CIP 1 zi <br />itap:ebr 7 PreXped Name Montt Day Year <br />460 hip7 Fierl`471494 7W I 91/ I zi <br />1 <br />CI <br />4 u. <br />40 <br />g <br />El <br />I <br />18 DiStrecerry <br />1 da Discrepancy Indianian Space L___J esetton ri Fu t Reethrr C Ouannty E Type LI%meter Partial R <br />',Weems Reference 1,44Pber <br />r-1 <br />lb Mamma Facility (or Gemmel U.S. EPA 10 Number <br />Fecoey's Rune I <br />g /5 <br /> 1 Sc. Signature of Alums* Faanly for Generman Month Day YE031 <br />I I <br />11aZattou*W4Sill Paw Vanagernerlt Whoa Cases h e., codes ter hazarlatis lenV keatraen1. *vow and f P5 SYS/W4151 <br />1 <br />0-1411 <br />2 <br />0.144 1 <br />a 4 <br />20 Designated Facia, Owe- or Operator Ca/thermal of receipt ct hazardous malenais clamed by the Mal except as wed in hem 18a <br />Ptiraedr arse 6,,,K <br />I Sigrgitv die <br />Month Day rear <br />I CI le/glai <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsotele. <br />DERMA= FACILITY TO DESTINATION STATE (IF REQUIRED) <br />(.111ALI