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Form Aooroved. OMB No. 2050.0039 <br />Pi ease <br />print or . (Form designed for use on elite Q pitcn) ry wmer.) <br />UNIFORM IfiAZARb0U3 1. Ge ermor ID Number • C,. 2. Page 1 of 3. Emergency Resfponse Phone 4. manifest Tracking Number - <br />f 006321479 JJ K <br />WASTE MANIFEST 1 so � t <br />5. GenaraWrs Name and Mawng" ( Gen tors SiteAddress Cff rent Wan mafiing address) <br />t�C�_�+14`jc;� <br />Co, .c��tt`�� l <br />��� <br />Genereters Plane: `� r' � U.S EPA 8) Number <br />6. Tmnsp 1 Com'p�a°iry Name [} <br />Ir <br />' <br />+ U.S. EPA ID Number`. <br />pawl Compiffy Name <br />8.0% FadGly Name and SiteAddress U.S. EPAID Number <br />CCU `>wj r . t <br />` <br />�Sft'Q11`)(h'l '7 -L� <br />Fad s Phone: lk. . <br />9b. U.S. DOTDesGlption (Indudhii Proper SNpping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />Quantity WtN01. <br />HMEnd Packing tmp No. Type <br />k L3 <br />` �J yCi�CYtiL$ t(CtL •y�3 1 )v \ , vo;i �vtS t r <br />t �!/•t�,�, ,tj�l! •,C� C v~�• <br />¢�,- <br />Vnsbudbns.andrAdd• <br />4. andling l d lnformation <br />1K GENERATOR1810FFEROWS CER FICAT 101 I hereby declare that the contents of this eonsigmnerd are fully and edxaately destxibed above by the proper shipphng name, and are classified, padorged, <br />marked and labalsdfpiacarded, and am in ad respects in proper eondMon for transport aceof ft to applicable intemadonal and na80nal govemnentai regulations. if export shdpmentand I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EFAAdouaaledgment of Consent <br />1 cartlrythat the waste minimization statement identified In 40 CFR 282.27(a) Of 1 am a large qum* generator] or (b) (11 am a small quantity rotor) is true <br />erreralorsi MeS Pdnted/ryped Name Signature Month Day Yea! <br />16.1rAnallonal Sh pmenls <br />El Import toVS. h0m .$ *� <br />r <br />Z <br />Dab leavLtg U S <br />Transportersig nature (for eikortsonly). <br />17.Transpoder owtedgmerdofRecelptofMaterrais f <br />Straka � Month Day Year <br />Trans pp tedffyped Name <br />r ( � <br />I <br />Transporter P Stgna re Day Year <br />18. DiscrePancy <br />18a. Discrepancy indication Space Quamdty ❑•type ❑ Residue ❑ Podia Re)actbn ❑ Full Rejection <br />Ma ildst Reference Number. <br />U.S. EPA ID Number <br />18b.Altemate Facility (orGenemlot) <br />3 <br />U <br />-it <br />W <br />Faddy8 Phone: on Day Year <br />160. Phone' Month �• <br />a <br />z <br />12 <br />19. Hazardous waste Report Management Method Codes #.a., codes for hazardous waste treatment, disposal, and rooycling systems] <br />T 4. <br />JAILIJ <br />20. Designated Facility Owner or Operator. C-1111-6- of receipt of hazardous materials covered by the manifest except as noted in Item t8a Month Day ea <br />Pdntedfryped Name_, 9th '�• -_ s - F„ -� , u. �"�. 2 ' <br />x <br />°+ - <br />- - �1' !!b'1'-- CIATGI'1 CAt li rTV Tn [;FIJFRATAR <br />EPA Form 8700.2E (Rev. 3-05) Previous canons are <br />