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2012-03-21 15:46
<br />5801 TRU 2094662259 2094640138 P 4/8
<br />Plonso print or typo, (Form deet nod for use on elite 12 -pitch tvowlierl
<br />EPA Form 8700-22 (Rev, 3-0$) Previous editions are obsolete, (`) DESIGNATED FACILITY TO GENERATOR
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<br />UNIFORM HAZARDOUS 1. Gonomlor ID Numbor 2, Popo 1 of 3, Emor9oncY Response Prone 4, M((eppn tyo1 Tyecytn Numbor
<br />WASTE MANIFEST /G L o t2 7} f '�� �j';4' ? tIGU• 4,?4-F�9pIT L I IChT1 flE:t: l 7 i J' Q:�' JJ K
<br />5, ConaSp;4(mee and lalllnq Adroso Goneralor'a Site Address (II differont then mailing addrosa)
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<br />Generators Phone: (�� `7 % V �-' ] ( `
<br />6. Tronsponor t Company Name FREIv1UiJ4L' E:'IVVIRONI�AE,AITAL, l•IERVICC , IN0, Rh(wic s; 10LI !i5Fi--121 4 U.S, EPA Ip Numbor
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<br />7, Trsneporar 2 Company Name 11 CENU.S. EPA ID Number
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<br />e, 0091gn3l0a FOClllly Name and 5110Addrosn 2'i "7 r GEEKTLJRY E.MI US, EPA ID Number
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<br />faCild 's Phone:
<br />ga, 9b, U.S, DOT Ooecrlptlon (including Proper Shipping Name, Hazard Claes, ID Numbor, 10, Contnlnors 11. Total 12. Unit
<br />HM and Packing Group (if any)) No, Typo Quantity Wt,Na1. 13, Waste Codoe
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<br />14, Special Handling Instrucllons and Additional information
<br />HZV0014: to be 40hr IrWriod c,ncl u�M RPE.
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<br />15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the Wntonla of this conslgnmonl aro fully and accuraloly doecribod above by tho proper shipping name, and are dhosieod, packaged,
<br />marked and laboledlplodardod, and aro in all rospocts In proper condition for transport according to applicable International and rational governmental regulations. It export nhlpmont and I am the Primary
<br />Exporter, I corny that the contents of this conslgnmonl conform 10 the loans of the attached EPAAcknowladgmonl of Consort,
<br />I Certify that the waste minimizallon alalemenl Identified in 40 CFR 202,27(x) (if I am a largo quantity generator) or (b) (If I am,a omall quantity gonorotor) Is true,
<br />Cenoratar Offoro51 n rs�(Intod/iypodNMe lure r t Month Day Year
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<br />1e, Intornational Shipments
<br />Import to U.S. ❑ Export from U,S, / j Port of entrytexii: -
<br />Transporarolpnoturo ((or exports only), ( j 1 Onto leaving U,S,,
<br />17. TrnnspolerAcknowiadgmant oI Rocelptof Matorials f ;
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<br />Tranoporter 1 PnMociT ypOd NO�ji u.,.- -, Slg lura Month Uny Year
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<br />le, Discroponcy r'
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<br />1I1u. Discrepancy Indication Spade © quantity typo L3 Rosiduo LJ Partial Rel"ll n U Full RoJem,
<br />Mnnlfaw Rnfnrnnco Numbor:
<br />19b.Alrornnto Facility (or Generator)
<br />U,$. EPA ID Number
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<br />Facility's Phone:
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<br />sec, Signature olAltgrnalo n0lwy (or Generator) Month Day Year
<br />19. HozardoUe W0910 Rupert Management Method Codo! (I,0„ codas far hozordOUL waste treatment, disposal, and recycling sysloma)
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<br />20. Designated Fndity Owner or Opomlor; Certification of rocolpt of hazardoue malonole covorod by tho manlfost axcopt as noted In ftam lea
<br />Printed/ Fypod Nama-.,, Slpn
<br />µ aluro I 1/ / r rq Month Year
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<br />EPA Form 8700-22 (Rev, 3-0$) Previous editions are obsolete, (`) DESIGNATED FACILITY TO GENERATOR
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