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N <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Apptoved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2. <br /> /�1 t 2 2.Page 1 of .Ems ncy Response Phos 4,Manifest Tracking Number <br /> WASTE MANIFEST �t• 000 O R� 373 X00 iii -7R`13 007268297 JJ K <br /> 5.Generators Name and MailingAddress S S Generators SBemaress(it amorenl than mailing address) <br /> -tvn(Yti 01WFn e N• �Grcllnc�l <br /> Po eox 94 <br /> CWTRE D& sats <br /> Generators Phos: <br /> - s <br /> 6.Trans potler 1 pany Name U.S.EPA IO Number <br /> i Comsic CnvirmrY)eAW Solu.KU/LS AUG 2 6 2011 1 Cjj00034('0)0 <br /> 7, nsporter 2 Company Na U. EPA I umber <br /> �l C� L L� ENVIRONMENTAL HEAL G!g i1to <br /> 8.Designated Facility Name and S'(e Address U.S.EPA ID Number <br /> G�oShydb+ + ;!3 Z <br /> tb3u4 C4 '114012 tis (NL �ic <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codas <br /> HM and Packing Group of any)) No. Type Quantity MAW. <br /> won 3 aus LI 13 <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information <br /> Wee✓' #9096 GYM- + I 1 &6w--V' er'Cy p <br /> z cr�lxuc�-7� Ryocl�s- 0 47Q-71035altf?21 t`#76qg <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this con nment are fuly and accurately desebed above by the proper shipping name,and are dassifad,packaged, <br /> narked and Iabeled1placarded,and are in all respects in proper condition for transport according to applicable international and nabonal governmental regulations.if export shipment and I am the Primary <br /> Exporter,I carrify that the contents of Nis consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gene a Signature / MonJp _ Day Year <br /> _u 16.Inlemational Shipments ❑Import to U.S. ❑6yod from U.S. Pod of enarylexk: <br /> Transporter signature(forexpods only): Data leaving U.S.: <br /> W 17.TransporterAcknowtedgment of Receipt of Matermis <br /> r Transpo r 1Nnuali Name Sigrater Month Da Y r <br /> A� i t <br /> NTd- Tran o 2 nntod typed Name Signatu Mont Day Ve r <br /> tge' It "44 <br /> 18.101screpancy .., <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ResidueRejection❑Full <br /> ❑Partial Rjeaction <br /> Manifest Reference Number: <br /> 18b.Alternate FacaAy(or Generator) - U.S.EPA ID Number <br /> I< Fadlitys Phone: <br /> w 18c.Signature of Alternate Facility for Generator) y; MaM`v ? Jy r ear <br /> Q jV Sti <br /> y 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and ' pis) <br /> 2. 3 . lN�7:?Zv <br /> 0 1. . '(. 4. � <br /> ' yy s1 <br /> ...:`7v\ <br /> 20.Deslgnale l Fadiry,Owner or 0".Codification of receipt of hazardous materials covered by the manifest ex es nded in Item Ise <br /> PdnaMfyp arae ' Signalu _Day Year <br /> Q <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESI ATED FAC YTO DESTINATION STATE(IF REWIRED) <br />