|
- ,
<br />Genere!or ID flurer NON-HAZARDOUSI. .
<br />WASTE MANIFEST • C."*.:09.:if ;SL: ;•.: 'i..--:-
<br />a Page 1 of
<br />1 1
<br />3. Emergency Fle.spanse Phone
<br />67;•'2s:
<br />4. Waile Treeftlag:Nrinther 22-240215 L i
<br />• ,.. q,
<br />.h4
<br />e_ v- 1
<br />,
<br />Generator's Name and Mating Address . , Generator's Site Address (if different then mailing address) CCU ci! Stoe.,414it, tairif r!r./,' J.4: 0211MM IZ:foilF4ta
<br />i'45 Vif...:4,0 44)400041 S4.
<br />glvitlit'iti i',..ik
<br />Generator's Phone:1.49'.51r47t4j r
<br />t=r,
<br />Ira/spotter f CoMpany Haim U.S. EPA lo Number 11.11,41t$Eit fAttlitTAIlli**ittritfiTe I Ci..410061114.1.1 '. 7
<br />':1 .:
<br />. ,
<br />Transporter 2 Ceinpany Neale U.S, EPA ID itimtber
<br />I ...
<br />;....
<br />4.!
<br />'
<br />Iti DeoJn edFafty Netriamtd Silo kir/rase U.S. EPA ID Number 6rs&V at
<br />) i0;44:4 iiirp*-st li•'4d Mc/ Vit.9, 1.:.A.1414/1 • .; 3, 'Xii 1 N Feellfty's Phone r / A
<br />T.,
<br />ifel
<br />N .- Z Waite Shipping Name and Description 10. Containers 11. Toler 12 Ural
<br />to. Type Quantity yitivol.
<br />CC
<br />LC
<br />u• W z
<br />•
<br />'
<br />, -z-3, . - .1 7.r4; ..,. .,,,,, A. i ' i i4 - ,r,
<br />-
<br />P i
<br />.,'
<br />:7.
<br />- 114)
<br />.;.
<br />i-=
<br />. 13. FpfyilkWaktfdrstrper.a od iftenINnforplfer\
<br />VO#
<br />GENERAT9nDFFEROR'S CERTIFICATION: I hereby declare that Ibe contents of Ole conirgament ere fufty and accurately descrtheclebovitOy the proper *ripping nen*, and ale classlEeil, *packaged; ;
<br />maricad and lebiled!Placanied, and are in an respects In proper condition for transport accordinglo'aptilkable feternalionat and national govathicerital regulations.
<br />Generattn's/Offeror's Prinled)Typed Nand /54'. (.., alum ., ; , ,,. ,, ; ; i A. i A . "Il et. 1/711.r.t k ':',I (;:' Y ':. eir"i If 11 e. 7( e , .-; i,iti) Cd ,ki etv; - • r.ii) il))1.e..-itiP1 ii41till'q .i.1.44,,!it .
<br />ManIfi ply . ,e,
<br />1 -.:ez.4"
<br />Intetnational'Shliknents I1 Import to U.S. III
<br />.1
<br />Export (rem U. Pert of entrytexia ,.
<br />- Transporter Signatum (for exports onlyy. Date leaving U.S.: cc 16,transPortei klmoviledg* of Airri.i.pt of Materials .' ,, ,
<br />. 2 tn
<br />Transporter f PrIbIpcIttygo NOOI Signature , / i1/4,
<br />.1
<br />i
<br />j i
<br />Month Day .4.1
<br /> bilitt 1 PtPi ii50 )..A-Vvr1 i --41h‘7.&eise07 ;e,.,, 4.‘14',/,..a•Pg 166... z a cr ,r-
<br />' Transporter 2 Printed/Typed Name Stonelike With OnY Yesti',
<br />I I 17. Discrepancy
<br />17e. Discrepancy Indication Space Quantity Type Residue El Partial Rejection Fur/ Rejection
<br />Manliest Reference Number:
<br />—
<br />I
<br />17b. Afternare Fadlity (or Generator) U.S. EPA ID Number
<br />Feallfs Phone:
<br />a. t
<br />w
<br />170. Signature of Alternate Facility (or Generator) Month Day Year
<br />I
<br />w
<br />. . .., , .
<br />1& Designated FacRity Owner or Operator: Sentace6on of receipt of materials covered by the manifest except as noted In Item 17a
<br />Printed/Typed Nettle ' - Signature Month Day Year
<br />' 1 1 . ik:' 41 r el. ix ' I
<br />-1:1. X .
<br />/
<br />(
<br />I --.., -e!.
<br />.,
<br />I -4
<br />-0 6 10496 Rev. 9/09)
<br />TRANSPORTER #1
|