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Please,print ortype. Form Approved.OMB No.20500039 <br /> UNIFORMHAWDOUS 1.Genemta to Numkr�( �OZ�� 2Pagetm ].Fmrgeayftesponsa Ptme I.Martilest TrssYJnA Numhr <br /> WASTE MANIFEST 1 114 255-3924 006105035. GBF <br /> So ah Nameantl MV=Aaliig ss �OVw�S•MA�I famemb! Sib Addres(dd dCMe`rypaA�m 1109 eddrees) I <br /> ''1Tap, cC--4c V clay \o YET`` <br /> ��tn.\ W Y Is2 �ion4 Wcs+ "Im (-J 0-Y <br /> tA— ZDA-f. Cor Sf+-IOD ,.1 SzU <br /> GYAdmtoleTFOnO <br /> 6 Transpader l Company Name US.EPA IO Number <br /> TERN car 1ULTE_ RECYCLING OkL000367042 <br /> 7.Tmnspoda2CompmyName MEP=ENCEHYV1RONN1ETAL US.EPA IDNumEADy83389631 <br /> B.[!signaled FaduyN.and SO Address LS ECOLOGY us EPA ID Number <br /> M5) IVY 95 n M S IF PATTY <br /> Gadri aPbona: 553-2203 BEA=, W X003 NrVT330010000 <br /> Aa, 9b,U.S.DOT Dmhcnpbon(mdudirgPmper Shipping Name,Havrd Class,IO Number, 10.Conlamne 11.Tmal 12.Unit 13,Waste Cod. <br /> HM and Peeling Gnmp(Avly)) No. F Type Comity W al <br /> 1, <br /> w �( i�I1993 \XPISTE FLAMMULE TIQUID OL DrA 700 -Y a <br /> w ? Z <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.8peabl HaMlingbsWNasandAtldibonallnblmahm 1.5s. %b702Ly22(—fl <br /> E2cAfr28 1157- PP2PFR -J MM (4` <br /> ER CONTRACT iAES9933011 <br /> 15. GENERATORSIOFFEROR'SCERTFICARON:EeportaIFareYydedare Vat meaments mbisoansgrmbnlare bYyaM aaumtey&smbedabove byrFaaopersbipptg wme,eN aradaasifietl,padageq <br /> maM1edaMbbehOlpheasshenta aremallrgptttlmgopero»dtan brbamapodamatlin9 baDPr�Ne btematlawlantl reAvW gumrmreNalregulatpu.IIereplsM1ipmentantl Iamdre Prvrary <br /> ION,, Onyeml Me wnlents Laos endignmeecl m 40mb bebmsoMyam a langeEomfty enetluce)a(bCormem. <br /> I ceNy mat tlb vasb rrbtimiratlm gaNmenl BenYSed in 40 LFR 26227(a)(d I am a Inge ewnY y genarab)a(0)(dl am a sma9 giwiAry gemralorl 6 Yue. <br /> ComrebfgUmname PbtW,1N. SgnaYaa Nmb ,D.aYy Year <br /> 16.InbmaSaW ipnet ❑bnpodbU.S. ❑Expodlrom US. patof'AymeR <br /> TrensparbrsgwWre(laewabonry): ate leanng U.S. <br /> a 17.TmnspmterAd.MMgmentafR.plm Matelots <br /> Tn der l PdntedGyped Name Signab Monty Day 3Year\ <br /> on Z zX C� <br /> on <br /> T z dote y^tl Name Sign Monty Day Year <br /> 1 18.Durepanty <br /> 18a.Diaaepanmylnd OhOSpa® ❑ Doan* ❑Type ❑aweene ❑pallialphimian ❑FW Relegbn <br /> Manifest Rebren¢Number. <br /> 18b.Albmab F priy(or Genemla) US.EPAID NwMer <br /> V <br /> uQ. Faullys Pune: <br /> 1aA Slgnamre olAltemate Fadi ity(an Generator) Mont Day Year <br /> Q <br /> 2 <br /> ti 19.Nazallom Waste Repo Management Mntod Codes(i.e.,oadas byeb <br /> r meardou mete Yeamma disposal,and mgding ams) <br /> wo 1. 2. 3. 4. <br /> 20.DeAmal6d Faaly Ormer ar 0pensom CenMoakn m moolpt ofharmdous ma@dalz m.Erod by the marNest ampt as odetl b hem ISa <br /> 1 �"�" Z E 0b W year <br /> EPA Fon 8700-22(Ra.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA'S&MANIFEST SYSTEM <br />