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000 2000 <br /> v• ' - m <br /> v coon <br /> X <br /> � w 00-0 <br /> TI a) - 0 u o <br /> 0 000 <br /> Q 4 L o 00 *k <br /> o C- C- <br /> FD�. °�° <br /> N) <br /> m 0 <br /> CD oN � o <br /> rn -m <br /> h <br /> 00` O <br /> 0 <br /> Ploese rinl or IYpe(Form designed foruSe on elite 12-f:I typewriter.) Form App,q,Sj QMg No 2CYusA,S < <br /> UNIc- MN <br /> AZARDOUS I.GenerelnrlD Number 2.Page 1 nl a.Emergency Rexpanee Vl,ono 4.Merdleq TgNlnp Numtxr J J K <br /> a WASTE MANfFEST rel-Yn rd r'- IOP-?fi3::157p o.'1L 77 <br /> h _ 5,Generator's Name and Mehling Atldress Genemors Site Addrese(t different man m nll eddnea) 3 <br /> Z <br /> C) <br /> Nor GBnwa19rNor t C: <br /> 6.Transf Company Name 11.5.EPA ID Nvmw,r Cn <br /> D <br /> 7.Tansporter 2 Company Name <br /> i15.EPA ID Number Z) <br /> 7Fr, 3 <br /> B.Deeigoelad Facility Name and Site Address U.S.EPAID Number 07 <br /> CD <br /> Cl) <br /> Faclltfys Phcne019270-915P <br /> 9a. 9b.U.S.GOT Desch hon findudln Proper Shi Name,Hazard Class,ID Number 10.Containers <br /> P 9 PPi^9 11 Ta1al 12.Unit (D <br /> HM and Packing Group(ifanyg No, Type Ouentity wlNoi. •" "- ti, <br /> 1, j 1 O.WA 0 <br /> C <br /> FLAMMABLE,P! <br /> w O <br /> 'W- FATE),5.1.PG til I .7 .7 07 <br /> a. CD <br /> N <br /> CD <br /> r 14.5pectal Handling Nell and Additional Infarmatlon 0 <br /> O <br /> 3) <br /> CD <br /> 115, GENERATORWOFFEROR'S CERTIFICATION:l hereby declare that the contents of this consignment ase fully and accurately descnbed above by the proper ahipplrg name,and are riassifer!,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condilien for transport according to applicable international and national gavemmental regulators.It export shipment and I am dre Primary —• <br /> Exporter,i cortify Thal the contents of Ihi,o^nelgnment XMlomr to the terms of the attached EPAACknowledgment of Consent, <br /> I cerdfy that the waste minimitalion statement Identified in 40 CFR 262 271a(if I am a lege quantity generator)er{bi(if I am a small quantity generawr(is hue. <br /> GenenilOsUfferor's Prtmedrryped Nam@ Signature Month Day year <br /> Cn <br /> � I6.International Shipments ��11 <br /> ❑Import to U.S. _1 Exportfrom U-S. Pon of entiyfexiP. <br /> Transporter signature(far"ports only): <br /> Dale leaving US s EF,Oily%Ph�ne <br /> rdnspoderAclmaAAmem of pt of Materialssposer 1 'n y d Ns Signature7 spoder2 Pdnl yped Name Signawna MgnCriscrepancyL Discrepancy Indication Space ❑p.n* ❑TYVe ❑Residae ❑Partial Rajec4un ❑FuB RejnCtion rence Numberlternate Facility(or Generator} U.S.EPA ID Number <br /> 51 fty's Phone- O <br /> h ignature ofAltemate FaCF14 for GenerawrlQMonth Day Yearzardous Waste Report Management Method Codes til cadet for hazardous waste treatment,disposal,and mcycling sysarrI <br /> It 1. y 2. 3, s <br /> 1 O <br /> (3T <br /> y <br /> V.fiesigmded Facility Oxneror Operator:Certification of receiph of hazardous matariais covered by the manlleslexcapt as ngad In Item 18a <br /> PdnledlTypod Nerne Signal O <br /> r;Q yI M°n ag CO <br /> CD _k 1 <br /> w <br /> 0 FPA Form 8770 7�IRe°.3051 Previous edifians are obsolete DESIGNATED FACILITY TO GENERATOR <br /> 0 <br />