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h rr <br /> ease print or pe.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS nerator ID Number \ [2.Page 1 of 3.Emergency Response Phone T Manifest Tracking Number <br /> � 0043-10839 JJK <br /> WASTE MANIFEST CX— (J ZS 21 1 ���c>✓'SS�`c1�`i� <br /> Tutor's Name and 6lafling fiddros Generator's Site Address(d different than mailing address) <br /> h W V� A 01,M"r 1 <br /> -1n. 1, LA2-0 I <br /> rator's Phone ('—I,- `'1 -A l—"1�(�1 <br /> 8.Transporter 1 Company Name U.S.EPA 10 Number 7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name a Site Address U.S.EPA ID Number <br /> Olt%.lJC_)Llt.l, r,l_A►.,tE-l4 •�I..,:mac;l <br /> , i.-k C_A -c%t <br /> Beit ty s Phone: f'fit()l &'A-1' (--- <br /> oa 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, L 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> Ft,,1 and Packing Group(if any)) No. Type Quantity wtNol. <br /> 1• 1.1r.,..1 l`t , V�.)�.�+"CE.. G7.�..en:,,.,nhl.<; Ltriutl t �l 1`�.c. s---- <br /> O 1,.1,CN,S L.ELA-i—i eA„_r Ar,it".%1EA\v.lA11L4'- 3b PC--,111 <br /> W 2 FOR RECr(tAM HAS BEEN NUALIFII:D <br /> TLING/TREATMLNTATTHE -- —�-- <br /> D�MF NN01100O G11Viiimilrigr <br /> 3 . THIS FACILITY HAS TLIE NECESSARY <br /> Pl,?M'1-S TO f?ECLIVE YOUR b'/ASTE ST <br /> QUAEIFI� ft' <br /> IS cnro�ooa,�35z -- <br /> pedal H ndling Instructions and Additional Information <br /> � l'C:(JC,L,.1r.i1 V\.ltbl <br /> 7�rJCL>'J \luta 1-1£'•L P, <br /> 15 GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arid are classified,packaged, <br /> marked and labe:ed/p!acarded,and are in at respects in proper condition for transport according to appCcable international and national govemrnenlal regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknoaledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gene sOfName Sig re Month Day Year <br /> RQ r 1"k 15 •ter-, D / >�� <br /> j 16 International Shipme <br /> z ❑Import to U.S. ❑Export from U.S. 4t.)Javing <br /> entry/exit• <br /> Transporter signature(for exports only): U.S.: <br /> Lw 17 TransporterAcknovledgment of Receipt of Materials <br /> Transporter 1 Prinled/Typed Name Signature Month Day Year <br /> itO <br /> QTransporter 2 Printed/Typed Name S gnature Month Day Year <br /> a <br /> 18.Discrepancy <br /> 18a.Discrepancy Indcation Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ; <br /> ❑Fu'I Re'ec6on <br /> Manifest Reference Number: <br /> H 18b.Alternate Facility(or Generator) u S.EPA ID Number <br /> U <br /> LL Fablity'sPhone. <br /> w 18c.Signature of Alternate Fad'ly(or Generator) Month Day Year <br /> Z <br /> iazardous Waste epqd Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 23. 4. <br /> . <br /> 20.Designated facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest exce)as noted in Item 18a <br /> PnntediTypediName Sign:7// Month Day Year <br /> \1 ,iia• - -- - U ( <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. �' DESIGNATED FACILITY TO GENERATOR <br />