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STS C .. 00 a9 . B726 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.P71of .Emer3ency Re se Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C- Z t0- qq.�S 0 000238771 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> KA II vqqZ5T \NC--- K N(-\ wtST \NC. <br /> iso-4t, ScPkPoQ.T 13U\-t0• .Soo r^,0,0¢•-4A oil. <br /> �.v• '5ACJlLAVAe,-4r0 cA. gS6gt t-P.t1�R�loP cA. 0.5330 <br /> Generators Phone: 113 L 41 A T 10N\ 1 <br /> 6.Transporter t Company Name U.S.EPA ID Number <br /> WLC- G Q. 000 O O <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Faality Name and Site Address U.S.EPA ID Number <br /> c(Los3e2Totit HC. <br /> 0030 cAb 07A g0LA4k'q <br /> 1-40nLh G eAc-W C A• 0,33 <br /> Facility's Phone: %.L <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No Type Quantity WiNol, <br /> 13.Waste Codes <br /> 1. Nom-(Lc-ILA HAjAQ Oc J-S wASrb' '�zoL\b OIZ 352 <br /> o Ilk <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> v5,z PR-oPt e PC-g-5or4AC PwrEc-nuc G,4JtpY%ervr �aa� <br /> .s0'6/P0!A, 3$ Z-,36 PILO FttEt;�-- 5-4 4Z(o. <br /> L -N enTAL ->�wmces 1,,t . 1 c' OIN r 4( <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations.H export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the temp of the attached EPAAcknowledgment 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 small quantity ge re e. <br /> FGen!TJl;l Pdnted/Type ignatu Month Da Year <br /> D vJ� 0 0 <br /> 116.International Shipments <br /> ❑Import to U.S. ❑Export from U. . Port of entrylexit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receript of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> 3LO <br /> Z Transporter 2 Pdnte0yped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> Faalitys Phone: <br /> 18c.Signature ofAllemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> G 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. A D FACILITY ESTINATION TATE(IF REQUIRED) <br /> 10439.1462 <br />