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NON•HAZAROOUS 1, Gene'alr'l 10 Numbi=r
<br />WASTE MANIFETI ' N/A . . . ...
<br />2. Page f el
<br />1
<br />8.Ernergericy Response P11046
<br />, $77,..236.;826.5
<br />4. Waste Tracking Number
<br />22t2:. 44(15.• 5. Generates's Nate-andliiiingiWees
<br />.'014lyt**01,04ipitijiiiiktO Willies Divisfon
<br />-745Wilit ..M11=4'.: . Std440170,
<br />Denotatoes Plie-h.e:.•' 2b9:93aliti0:::
<br />001.004.SalildrikaliTtlillerintlhan m'ailiteirdreis)
<br />8. Transporter I CoMpany Nate , '. . U;S. EPA ID titirn8er
<br />..„.Ponder.1446*1.)011,31ServIces • ...: - :,..„,.,..
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<br />tTiansporter 2 Company Name U.S:EPA10 Itiltbei
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<br />-. i . , i haled Focil Name and $ilo Addre3s t) .S, EPA ID Number
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<br />.74*4324617 ''''!'1' 7 ''- ' 4 . Iftit0,#.010 -8 9 466 , .
<br />9. Waste SitIpPlit Nita end De4cription tp.A*6013 il. Tail 12. Unit
<br />Nc. Type ' ettor.ltk . Vliktol. k _
<br />.t.i I. - Normazardous Visite Soad,(HydroaubOa Inipattecito - '.!
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<br />A-26029
<br />11. - Instructions and Adeonal Intimation
<br />168,1.', • -t)r 5-9 e::
<br />14,•egNERAT0R'S/0FFSR0R'S CERTIFICATION: I hereby declare that the contents of this consigentent are fugy and accurately described above by the proper shipping name, *Am blaSsVed, packaged,
<br />. Marked and fabeladiplecardeO, and are in all rscpecte In proper ;pettier' lor franspOn oOccorig to -flippticable international # national governmental regulations.
<br />GeneretoralOfterott Printed/Typed Natit .e SIgnalaa Month. . ,
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<br />1$.1nrein Shipments - ,. ' — ..... A,
<br />Import to u.S. El Expdrt fOrn1.1.8. l'- - Portotpithybo .
<br />Transporter Signature (for exports °Myr . bate Melee tr S •
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<br />%Trompeter itckno*edginent of Receipt riAetedals -
<br />Transparterrl Printed/TY* Name VISO4 - - . ___.--...: .
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<br />Year a - - • ...... 1. .
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<br />A - "2-. .. 14 r ' . RAO r3 s 1,/ . 0' .,
<br />Transporter2 PrInted/Type d Flame $grieture ., Month ny ear.
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<br />Discrepancy
<br />17a. DisGrePancT illolotign Spice II ,.
<br />Quantity Type II Residue Partial Reic-ctiOn D Full Rejection
<br />Manest Reference Number.
<br />175, Ahernile Facility (or-Generator) US. EPA ID Humber
<br />Facflitles Phone:
<br />17c. Signature of Alternate reOfiy— (yfuel .Fq,--- --... Month Day Year
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<br />Designated Wily Owner or Operatoc **alio of :-.. • ,t of mat . els covered by the manifest except as no iin Item 17a
<br />Pfiritedly0ralNaine Sleneture
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<br />DESIGNATED FACILITY 1-0 GE N—j.14140 169-81-C-1) 6 10498 (Rev. 9/09)
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