AppendixNo.

3 (Y)PL)6*l-#/c,A'¢'o2_ , //2+
N@nifestOfTran§poruton|)ispesalOfNowhazardousWastoandCorfuctionWaste.Li4l.ljAj5+bedlj±t]qul+.odit4.j `|ai?a-t±IUrila2±jEnvironmentpublicAuthorityaJapa-ulairdlIEnvironmentpublicAuthorityaid+lr4.ulai±®llIndustrialEnvironmentManagementlndusti alcrimescontrolsectiona¥`i.-l diJft+rsallA. aa±£ti-l -tl aL)Li!Telephone(-41+.ojif):2220831oKuvraltMunicipalftyCleaningDepartineutazuiiJlajljl/I+ajsl a!Jt|wasteSoLirceattai«(jJL-)ateKuwaitMunicipalfty/EnvironmentalAIfairsDepartmentaJedlo9ij}5jl-I/`=+±9£IlajltITransporterJlun
CopyTo (jajul)
CopyTo (Jail)
CopyTo (.ajuj)
CopyTo (jaiul)

(A)InformationontheSourceofWastecfdLdy( I )bL -)-4tr lt ai!l

1Jhewasterfredjo±nparagraph(b)gft his Article has been collectedifaca2.~ -. I. sbsaiic,tsuni -Lrfu)
From: . .petmName(qu¥l).Wr+..2 .TelephoneNumber(iJE2.Havebeenmovedto Its.P.aL.„.„..`Pm.ffky.......Designation •.„. . : (cpTOJa2J € Lj c+rfLJ(aapg«)`}lsEi. . th.ng.. Address(®i.i.i ). . . E3\^r=e..aih. . . . . .i.|„. . . . . . . .FaxNumber(oflaJlr2Li). ,. . +mnytandhdrfuldpuL\andtith

tw riLj) .q2.2-...q5„.1....(J'un,f3Jig).i....

Address(otapi)......S*.ulEL`ibjis`.........„........TelephoneNumber(il3"fij)....~.........
I certfty. 0VehiclePlate
thatth Number (
wasteslistedonthevehicleofthecarrierm®nuoned inparagraph(C)(g)6j2allejjsnlLBliJlafu-gLc6L,jsnlt]tuLalij±.a3p3Ddjlj]l

a£J, a-jJ r2L,) I .........gLoading(jrdl9 .cltoch,.LJ£):......".....J.al..tt#..I.--.- (a)WasteDescription

INumber of Cont
ainers ( .....„.I.. ... . .. ... Quantity (-+£.Slt) i .......2~ J£......... I.

(+)4tunldej
Unit(6Lbjll):...I.a......Signature(efjfri):........„..Time(afui):.9.i.a.a.....Date(toui)!\mL2J.Lo

1. General Description of waste (abuLinrle L-toj) :

other (Specify)((,Le)GJii)
I I Liquid(aJfl")
::u#; I ,s#-s#d,
2. Status of waste

I (S#,
(atlii]I -all) I

3. Waste classification

%:i(;5ef#) I
(I.tliijt d±iLa3):
IndustrialWaste(-drb*u-aaturi)
I Consjrausc,:ona,
(a±LLi! t]t!uj)
fE
MunicipalityWaste

(a=!Liij atla])
I
4.WasteData (-t!unlcfi±ut+): Ccjwhch`c^ WaftL ` ivotd
Wasteweight(Size)((redl)at`alnoj9):.......IomE„.............NumberOfVehicles(ciljl±,,,]ljLLe):..:....\..........

Load capacity (aJ[}+edlaa..)i |V-Tor`+

1certifythat1havecollectedthewa8tomentionodinparagraph(b)andthattheabovedateiscorrectandthatalloftheabovedatahasbeenfilled..D)I.i5L,jsdilaut±{ne±->al±f3jEdjija9tap6Ljrfnialit±iOlj(+)6Lfaw@5L,jsiliatlaiJi`:I-.9.n(+ji,Ill

Name (qu¥l): „„„.. Ai.nd5,„... ., Designation (aa±apl):.„..lDT\\ctir..„...Signature(e#gin); `or`u ..-

J3u,(€`).4j:i¥
Time (aful):.....„...9.;.aa .... ....... Date (a±jut): ..I...# /...I.2,./....3aa.9n...„„

Address : (oljJJ=) „.Bre4!*£r4q„..... ..„.„ TelephoneTransportationLicenseNumber(JaiJlu4±i Number (ili3¢l r2L>): 2123AWG?.. Fax Number (o..SlaJI pi): .. ... ..iP,1......2tE@62_.n..u..t>c*€=±.„.`..g+.9..Inuxp.„`n..

1Celtftythat1havemeeivedthewastesne(ajjt2ii>ii~iLiifalsj.iiac
(D)ThePartythatDisposedtheWastegiv'a l'(-)cpgivl?JLeo
jannd,°=dL|:a:,=P:.I)#e±T###:Lca#9aoroberLpi#:d{n:)thae#C,'°;8:#n=,:###givfith#Lry
The Wastes mentioned i n ParagFLap`h (b) have been destro ed at (e}j-¢ (+) 6J2aJti 5.jsnl abliijl)t cr a-15.3ll f3 LnL9)

Waste Disposal Method (4tLiiJl cp ual3E3ll aiula):

Other I water I Treatment I Burn I Healthy

SfrrayjnugdrL'9' fill,ng(grr.J) dblail'
(specify)((|to)¢Jii) a.dfu (6Lp)

I ~

A copy of the waste lis (shouldbeplaced.' ' -=Tej9+

 `F;i;;iiiiii::-i.--t:fF:SL ;`:,.I c /{j ../[ `/!;;i`:i I I.

ManifestoHran6pohation,DispesalOfNonhazardousNIsfeandCorfuedonWatolL+I.|gAj5,laallj±+tit\aillc~li:llr.jjUaija-tinua]la2±g
Environment public Authority aiedl aAul aiedl I Environment public Authority ail+ll a-Lali al±di
CopyTo (Jail)

Industrial Environment Managomeut Industrial crimes control section -4rtLdl I.Lal6tll? rsidl r..a a±£ti.-» aJedl iLil4
CopyTo (jajri)

Telephone (aJIJ+.®jal3) : 222083|0 Kuwait Municipelity Cleaning Department a2\laill aiLil / drjsll adJ1? I Waste Source dtliill (+I-.) a4>
CopyTo (jajul)

I(uwait Municipa[[ty / Environmental Affairs Department ai±+ll ciLgifr ajl.I / `=ti£Il a±Al+ I Transporfer umJI
CopyTo (jajri)

s been collected•.-:(cp+aLfiJi a 5Ljjsili t2btiiJi ep r: LLaJ) (A)InformationontheSourceof

i.I:i:wpafe=edied,to!rnEaprafrapi(#|,o#i§&rtic!|a
Name (Hm) hi.^...Zhanj... .. . .. Designation (aa#jii) ..h&E...ttarmJGf4r.. Address (olL91m ..B}.€.c`n...........
Teleplione Nun2.Havebeenmober (I.:twpLt) .....a.2G|.S.g::±3.L,.. ..... Fax Niimvedto(jluaiJlp3|iL9)i*...„...r.`r`L:i..raci4...nuber (Lyfuifl pLj) .......'r\,cipe\thJ+iedfu Wastepec,bdy ( ' )bLL~)-dcatl aun'

Add ress (®ijiali )1cortythatthowastesli •.......Sul.dsi*...--..-.stedonthevehicleOfthecarriermentionedI...... Telephone Numbinparagraph(C)(a3LPI8er (.j3tol' riL,) ........jjsn`ullijiafLruLciL,jsJlidtlaili.ririJaAiljil

VehiclePlateNumber(afjlla~lriL,):.......I..3*.-*.„L.g..L..„.„ (a)
I
I 11= I . ,
Waste
Description
Number of containers (a\ig`-ll ate) : ... .. ..... ...„.I. ,. . ... ..... „ Quantify (a±-Sll) : ,,. ...2Jb„... .rx`?„..„„..
(.+)atjtaJJ'dej
Unit(6LbjJl):..rf......Signature(e£9ili)„.`„.........„Time(a.cwi):...I^'Aa.Date(ai,tili):l*ml2--2®,2..a

1. General Description of waste (dt\aill.ledej) :

other (S pecify)
((JLL>) CJii)
I (LfuLd, I Sludge
'sw I 2. Status of waste
Semi-solid
(ade 4rf)
I (dttaiJl aJL>) :
Solid
(ade)

3. Waste classification (4tlaiJ' ij]±jL.a3):

iale
?::i(;ge£P)) I ln#asttr I Constructional E Municipality IWasteWaste
(.drtia#hodtuLi) (a4Lij! dt!lai) (a±Lil± t]Lj\ai)

4.WasteData (t]tsLallpealitr): Co/\s+.i^ch.e` Wtrshe_ ` h/oi>c/

Wasteweight (Size) ((prdl ) atlaillojj):.....2D.,.mi. „...... Numberofvehicles (alj\±qj` jLe): „;........\....„

Loadcapacity (aJg-allaJp)I 2u Tovvi

1certifythat1havecollectedthewa§tementionedinparagraph(b)andthattlieahovedateiscoITectandthatalloftheabovedataha§beenfilled..®)lei6Ljjsnlcie\±lcp-d±±r3Aa4JigajEpe3L,jsillcitiwlcjl9(+)5Lfall@aL,jsillEltlailicLae9-AijL}l,El (C)The

Name (qu¥l)^..„.,..A¥o\^b.,. ,.. Designation (a4+ajjl): „„.„tinu.ear.........Signature(e±9ilt). . o'-_-_-_

Time (-ducul).-..........+'[ ,a.a... .„„„ Date (chlill):..I.4„./../.2./. 2¢2uB„„„...

Address:(oljJ£)„.„Brfme4g..............TelephoneNumber(`d3typ2j):12.2M3c#G+FaxNumber(uifuipiu):......

TransportationLicenseNumber(.aijiu4+,]f":....2.6:62...............haed,.`...a;I..q.JJhaL*.....„.„

('#rrat#av,e[=fithiffijE°,°kedL|:#P:.I)#e¥¥j##:Lse#::fgaore#i##:":)thae#C,1°;8:#:,:V£I###Tfide## (D)ThePartythatDisposedtheWastetp'ied'(.)cpgivL'c-a

The Wastes mentioned in paragraph (bV\ ) have been destroyed at (ciLgr ® (i]) 6+a£L!l? ijjsill ablaill)` c~ u4lii:ll ¢ LnJ)
I
Waste Disposal Method (iatjliill +- ualjtB' -4a±jJa)I

Other
(specify)((,to)jJii)
I Water
sEayjnugoil,9'
I Treatment
aalha
I Bum

(GLP)
I Healthy
fill'ng(tperJJ)
ir I,,un'

Signature (e±9ill)' ..`..." -... . .=. . . .. ..

A c.::y,:I,hirqas:e=:=ugldL:e)Placed. ~ \ dif
#eri=J
-
 AiripravrdirxNr>.3 r!+) rfejr3AA oi-/{f / pf f i rB!±2=
NanifestofTramsporta«on,DisposolofNonhazardouswasteandcorfuctionwastoou4I-lj-ji+bi"ridtunlgivu4Jjdlr.jju2i?a-en'`|aDlfap
copyTo (.airi)
Environment publicAuthority aJal -a-ul awl I Environment pu"cAuthority air+ll a.ul ai±®N
CopyTo (Jail)
Industrial Environment Managemerri Industrial Crimes Cant rol section a#liJl alaJ`iiLL? Psst:ll rA a±c`i.all ai±+ll aL)lut
CopyTo (Jajmi)
Telephone (aJLL..®jaJ]) : 22208310 Kuwait Municipality cleaning Department aiuiill 5L)lil / rtyl a]Al? I Waste Source ekuJjl {jil~) 2®
CopyTo (.aiwi)
Kuwait Municipality / Env]ronm®ntal Affairs Department airil ®jifi 5Ljl.I / `=AdosIl adult I Transporfer LPLiM

ikp6r::rap#b#his Article has been collected.,.(a..€32.......i(cHL]aLfali S ajjsnitituLiJie* r3.2J) (A)InformationontheSouroeofWastetFdil.dy( ' )b-)-4eratlail'
i..:i:wastereferreT3
Naine(qu¥iltlr.....apTelephoneNumber(us2.Havebeenmovedto .. ... .. Designation (ai#+I) ...ttsF ... . . . . . Addresber(rflaJIGum`.fiL.t>ha.. . . s(®tjinli).,.Bhgrach„.......L').....--.LriiE.I.:I.`ri',i.I:`.I.I.'.I.`.I.'.''.I.
`¢ll rill) ...a.I±..95..1..a..I. ......... Fax Mum(JIJ2Hldlij).....I*...h¥„..yi*d......in

Address (otapl)1cchfythatthowastesli •...... Telephone Numbelnperagraph(C)(a5j2ille r (.ji]rty fiL') ....-.........--jjsilluaula=£LruLc5L,jsJllat\aillu±-:r3ddJijal

sedon&th*h#ifemermentloned
VehiclePlateNumber(at£JIIa-jlPLj):...............I.iI*..2-5..I........ (a)
Distance ReadinNumberofCant g Durina'ners( g Loading (Uprllt 9lfil -di`uli 6,ip) : ..aqgtJJ'JLe):................,I.......... WasteDescription
Quantity(arfi):.......„.....fu..t*.......„
(tJ)dtlaiJ'dej
Unit (iLbjJl) : .in?.„., ....Signature (e£9ill) F ...... ...........Time (afut) i e:..:...a.D... Date(6tuul) : .I.*...I.2..2*!2~

1. General Description of waste (dt\iiljru=dej) :

other (Specify)
((I)b) 15Jii)
11 Liquid
(aJil,)
I Sludge
(gL-)
LI
2. Status of waste
Semi.solid
(.trAri)
I (dbuifl all) :
Solid
(ade)

3, Waste classification (a|!`iill iJ&±ii4a:):

IndustrialWaste
I cons#sc,:ona' H
MunicipalityWaste
L|
?::i(;gef#) I (a±`&i! t]tiii) (ajLil3 `±tiaj)
(ahou. a¥u. dtuLi)

4.WasteData (i=tlaillcFcilitr): C;7\s/M{rfucy\ WngtL / WaScL

Wasteweight(Size)((prit)i=tlail'®jo):.......2rfu...m3.......Numberofvehicles(a|,u'jLe):„.;....,.......I...`..

Loadcapacity (-alj.sJ'aa-): 2,Lt T6^L

1certftytliat1havecollectedthowa§tementionedinparagraph(b)andthattheabovedateiscomectandthatalloftheabovedataha5beenfilled..O)leis.jsiii`=Litliepaip]p3A2dJiga5tpe5jjsniati|ali®lu(+)aLFalieaLjjsuicitlaili`="rA2t+ii,il (C)Thepei+?:;::`: ?:?` :~;`; : ,

Name (qu¥t)-.....4=}a.nb .`...... Designation (aa±i+I):„w.D.f;`th~ .....Signature(e£9fll): A " __fa

Time (ai=ut):.......... g}^.a.a....... . . . Date (a±jal):...It./„..I.2J...|bla...

Address:(olji.c.)...„.grgz~:I.......„....TelephoneNumber(diuIpj)i.12Jrkde.#.g*FaxTransportationLicenseNumber(Jaillu4+,3Pu):.......2Gr.62.....„....„iul` Nu:[e;(i:I,;J)

1Certftythat1havereoebedthewadeslue(arid)irmiLJfais,ua£ndonedinparagraph(b)Oftheabovecarriei&thatthe8aidoataarocorrect&thatreadingthovehi¢le'sdistancotraveleduponreedplofth®shipmenljlaaiiamia.i,±®L.IdeagEaparfnic.Li\ri.chObelLpd.:cp(+)aLfilte6L#sni&ha`2ili`=A-lIAAB+fil,al)
(D)ThePartythatDisposedtheWastejiJ'aed'(.)ctudrmbtinui

Theys*espen tioned i n aragrapR(P ) have been destroyed at (cagr e (+) 6L,2ill! 5jjsill dtlaill)` jp oaffil r3 JiLg)

Waste Disposal Method (dbtaJjl cp L*lsEIJl a2ajla):

Othel.
(specify)((JLL>)JJi')
rl water
Sfrrayj;n.gi.fr,
I Treatment
aJtJfu
L| Burn

(6J-)
I Healthy
flllln9(tfror-J)
fu
l=blai''-

Name of Site Manager (e?all j±L. I...l)S ..........

signature (e£Jil'): ... ....'

A C::y,:t,hirGas;e |S:ugldL±e)Placed. jty=#=±