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bbL yK bH 1IJ* 66111Jnti4u 1111111111111111111111111111111111111 aaaics Please print or type. 356197 s Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number !1i tLk2�Li�.i`t it! 2.Pape 1 of 4.—Manifest anifest Tracking Number „c5WASTE MANIFEST e 0 0856197 0 SKS- 5. . Generator's Name andMailin Address Generator's Site Address(if different than mailing address) U' Nei i i y :41- 1 -5edb L Hairiper Ln ',.u-'I U-K I UN LH ` ne 1 c—Ct$14 !v-:ADD-i�!19 Generator's Phone: 6.`73 rt?rY-Q ePT- "eSYbIIzfti 1NL U.S.EPA ID Number I Xl'k!+00Li0-14,.1;w0'' 7.Transporter 2 Company Name U.S.EPA ID Number LLt 14 if#�t?t3Ufg L-.NV bVL dNL. mt-iu0JAIJ4.r-CCt)V1 8.Designated Facility Name and Site Address L LER N .hHRbUHb ;BHN J UbF- U.S.EPA ID Number 10e1 i3l=KhYtbbH KURD 6HN JU L LH �t1t3-441—kt fib,`' t.:Nll4f:;':i�+'34.�1 tis Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1 NUN--HLHH HHLHHUUUH WHb 1 b, SULiV, a ac l tiL OUb i HISID M14UHiN1Nb WHb t L lie), UJ i 3. 4. i 14.Special Handling Instructions and Additional Information 1 L„j1,);aJ H'j 116184 UH 144b 1 f.`•ii_'i it4H �t�itHo i 1U1,'Y fa J4�— �ti-1li�i�;—i:t%I K/ It-i--LOntract retained Dy generator canters agency authorit on initial transporter to add or substitute aOditionai transporters on generator's behait. 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and nationnuantitygene l regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) ' am Faallor)is true. Generator'slOfferor's Printedrryped Name Signature ! Mon Day Year J 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: M 17.Transporter Acknowledgment of Receipt of Materials Month Da Year Tran r 1 Prinled/Type,�f�m w — Signature n Month Da Year Z Transporter 2 rintedffyped Name Signature Y F- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue Part ejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: Month Day Year W 18c.Signature of Alternate Facility(or Generator) Q z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2. 3. 4. rpoDesigynated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Year ,ped Name Signature Month Cay PA,�rpfRhe41�? j7)i Previgusedre pbsolel—3R DESIGNATED FACILITY TO EPA's a MANIFEST SYSTEM b