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02/09/2011 12:24 209-467-0654 <br />t. <br />Plegse Print or type, (Form desioned for use on elite N 2-pitchl tyngvrifar-) <br />CONTI MATERIALS <br />PAGE 02/03 <br />EPA Form 8700-72 (Rey. 3.W Previous adItlons are obsolete. GENERATOR'S INITIAL COPY <br />-- —1 . 1 1. — I "". "'. 4VQVrvvo' <br />t UNIFORM HAZARDOUS 1 GenoraDor ID Number 2.Page lof 3. EmergeuicyRaSponse Phone 4, Manifest Tracking Number <br />WASTE MANIFEST 007267 JJK <br />5. Generator's Net" and Md- Inq Address Geniftfor'i Sltb Ab toss Ilf diflorml than malling acifts) <br />fill. <br />6, Transporter I Company Name .41,.; j.;ji 1.1, U.S. EPA ID Number <br />7,1Y.vuporieF2CdirpanyNeme U.S. EPA 10 Number <br />8. Designated Facility Name and Sk Ad*M U,S. EPA fl) Number <br />v V. <br />Sib, U.S. DOT Des;9 fkvc� V-rolpaf 8hp#rtg Name, Hazard Gass, ID Number, <br />10, ContatnersI <br />I. Total <br />12.Unit <br />MMand <br />Pzleklng Group (It arty)) <br />CILIMMY <br />Wt -Nd. <br />Ia. Waste Codes <br />No. <br />Type <br />Uj <br />�5 <br />2- <br />4. <br />14, SpftM handlIng Instwtiorts and AcIdItional Infornridon P.6 <br />15. GENERATOR'S(DFFEROR'SCUTIFICATION: I hereby declare that the carrierits of ails consignment are fully and accurately doscil bad above by the proper shlpping ruinte, and, ire clawlflod, packaged, <br />marked and lebeled/placardsd, and are In oil respects In proper condition for transpon according to appItcable international and national pverrimwitel rogulallons. It export shipment and I am the Printery <br />EXPOrt0f, I certify that the contents of this w-6ignment conform to the terms of the attached EPAA6nv*edgmBrtt of Consent <br />I certify that the waste minimimlion statement Identliled in 40 CFR 213=(a) of I am a large quartilty generator) or (b) Of I am a small quantlty generator) b true. <br />GenerEtor'sl0l'I'mr't Print9drryped Name montm Day yoor <br />Y11 <br />M <br />—j16. <br />P.- <br />Intatrietional Shipmenis <br />11 Import to U.S. El Export from U.S. Pod of ctya)dt: <br />Transpor1tr signature (for export only): Dote leaving U'S.: <br />17, TransportErAcknoNiedgment of Receipt of Materials <br />Transporter 1 Modriyped Nernst r t Signature Monih Day Yoor <br />v <br />X <br />TrwRpnrIar 2 PrIntedrryped Name Elgratre Margh Day YO. <br />18. Discrepancy <br />188. D"psncy lndlcRVon Spaceauentry Tya ❑ Residue ❑ Pallet ReJactlon ❑ Full Rejecdan <br />MantfBetReferance Number. <br />18b, Altamaha Facility (or Generator) U.S, EPA 10 Numbw <br />Fac1ty's Phone,. <br />18c, signature of A% -mate NcAlty (or Genstar) <br />morrill DAy YaAr <br />19. Hezardoum Waste Report Management Method codes codes for hazardous wrote ireatmeN, disposal, and rwAhN systems) <br />W <br />12-7 <br />4. <br />Designated Facility Omar or Opera& Cerfication of racelpt of hamrdo", materials covered by the manifest ammot as noted In hem Be <br />Int.,pod Name Signature M" Day Year <br />P1Ty <br />EPA Form 8700-72 (Rey. 3.W Previous adItlons are obsolete. GENERATOR'S INITIAL COPY <br />