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Please print or type.(Form designed for use on elite(12-pitch) ter.) Form Approved OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generates ID Number -71 Page t of 3,Emergency Response Phone 4."hof t 7 ac in Num <br /> WASTE MANIFEST cn[iloft 1 fi.J4 iW-1244W_(. u 3 2 7 JJ K <br /> 5.Generatces Name and Mailing Address Generator's Site Address{if different than mailing address) <br /> CENTRAL. %FJIJWy Irk: <br /> I si I t5 00f--1*,3'11fAY <br /> Generator's Phoni +JKI-1? i <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> i'ftFdk.a)V.i?A/Vik,04UlE14TA.L af.RVICt- 1W. 0h1 0 t3ix)-:vh5..12if4 i.,,JAtkdrt I1t31Y <br /> 7.Transporter 2 Company Name U.S.EPA ID Nunber <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> EVE ooftYtN Oil mk c',4i;i3i f1r387i <br /> tRW);;pAM7fi AVE <br /> Facility's Phone. <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 M� 13.Waste Codes <br /> 1 Nc)rs Ft tiA V iarar 1pxr5 V1f a�kr t a t r'iTeC P1tcArhatn VZeess r 1 C I i; i Asci <br /> 0 t <br /> Z 2. <br /> UJ <br /> 0 <br /> i <br /> 14 Special Handling Instructions and AdcIAQnal Information <br /> iLANDI F n I%i -fpr i KA)R EftA194-T.)A j' i5 Vi I'c <br /> 15 GENERATOR'S10FFEROR'5 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 Iabelediplacarded,and are in all respects in proper coni for transport according to applicable international and national governmental regulations If export shipment and I am the Primary <br /> Exporter,i cerlify that th contents of this consignment conform to the terms of the attached EPAAcknowledgrnent 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)('d m a small qua fRy gene is true. <br /> nerelor s1 e 4 Print di Name Signatti Month Day Year <br /> i <br /> LJ 16.International Shipments <br /> 2 ❑Impart to U S ❑Export tram U.S. Port of entrylexik _ <br /> Transporter signature(for exports only): Date leaving U S <br /> W17 Transporter Acknowledgment of Receipt of Materials <br /> Transporter lP'ntedlT ed T ! S n Y9en <br /> 2 Transporter 2 I'rintedlTyped Name Sign hire Month Day Year <br /> Q <br /> F <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space ❑ Quanlily ❑Type ❑Residue ❑Pa:^al Reluctior ❑Ful Rejection <br /> y Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U S.EPA 0 Number <br /> 1 ' <br /> U <br /> U. Facility's Phone: <br /> W 18c.Signs"of Nlemate Facility for Generator) Month Day Year <br /> a <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 of Operator Certification of receipt of hazardous materials covered by the manifest except as noted in hem 1 Be <br /> PrintedrTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. (GENERATOR'S INITIAL COPY <br />