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`Ganeratolp, Mail a copy to'. a T SC P.O. Box 400 Sacramento, Ga. 12-0400 within 30 Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR EC VTA. IEN T UNIFORM HAZARDOUS 1 • Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number L� WASTE MANIFEST eP,20 , e��i�� 008 6 5. Generator's Name and Mailing Address n Generator's Site Address (if different than mailing address) • f g%/ �sr�•c�.�r�I • �f z�s` N 0 V 0 4 20 Generators Phone: 6. Transporter 1 Company Name U.S. EPA ID Number ENVI RO N M E E4a��r::, �ntei{ cervices GA;� 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number FWorgreen OIL Info. _ _ 6880 Sm11h Ave. CADS 74'18? N1 vA n r C:. 946W Facility's Phone: > 9a• 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (If any)) Quantity Wt.Nol. tY , i r 1. �>f�"'�¢fi¢f f /�i>✓l�` �`�'�✓��i�# fl ii'%E�I"r�2�� � f'-8� i> � - O X � LU 34/ a. 14. Special Handling Instructions and Additional Information 15. GEN ERATOR'SIOFFEROR'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, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (•rfl am a small quantity generator) is true. Generatora� rs Printedrryped Name Signature Month Day Year !- 16. International Shipments ❑ Import to U.S. El Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: I= 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name ` Signatw&--- Month Day Year Z Transpo r 2 Printed/Typed Name Signature Month Day Year t- 18. Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Partial RejectionFull Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J_ v Facility's Phone: W 18c. Signature ofAltemate Facility (or Generator) Month Day Year Q Z N 19. Hazardous Waste Management Method Codes (i.e., co�Idess for hazardous waste treatment, disposal, and recycling systems) LU G %Report 1 " � 2 /L f 3 �—��V1 4. 1 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed[Typed Name Signature Month Day Year C'—..�N rte_ yy� EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR EC VTA. IEN T