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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved,OMB No,2G50.00M <br /> UNIFORM HAZARDOUS 1 1.Generator 10 Number 2.Page I of 3.Emergency Response Phone 4.Manifest TmckInq Number <br /> WAVEMANIFIEST SLE <br /> t <br /> 5.Geftfatms Name and Mailing Address -:99 N drierent than malling address) <br /> U.S.EPA ID Number <br /> W, <br /> 7.Transporter 2 Company Name U.S.EPA 0 Number <br /> B.Designated Facility Name and Site AddTess <br /> U.S.EPA ID Number <br /> RhWbn*'CH Thlwkicl-LL.0 LOWW316 <br /> Cit CA <br /> Faci..ly's FhGr;=. <br /> 93 9b,U.S DOTDc�pbcn(in,king Proper Shipping New,Hazard Class,10 Number, i 10,Costa nets. 11-Total 12 Unit <br /> oral Fa:7,lrig G tp III No. Type ousatty Wbf. 13,Waste Codas <br /> , <br /> ilc 'NDXt RCRA MIZ,AT=us TIVI )k1-1r FE.UQUV)(Oil ly WATM <br /> a <br /> L) <br /> 4. <br /> A I R 0 <br /> 14 Spadal Harding ImItructims and Additional Information <br /> 1). ACT4705 Sr%.__ <br /> 15. GENERATOR'SIWEROFVS 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 IabeiedV.arafdea j and are in afl respects in proper condition for transport acconflmg to applicable inlamatfmal and national governmental regulations.It export shipment and I am the Primary <br /> ExXrtei.I certrfy that tht oDnlants if this consignment conform'o the terms of the allchad EPA Acknowedgneit of Consent. <br /> j certify"tli sle Tndnlza ion staterner I.identified L-1 A0 CFR 262.27(a)(I I am a IPTg'e quantity generator)ori lb)jQam�sZfta;l quantity generator)is true. <br /> Gent hn ame t atV0-fl7—=ftV- Y, <br /> —"o, "n ly)I -#- 15 r- <br /> T -1 1 <br /> L �. <br /> El import w U.S. -E] <br /> .Export from IY.S. Po t of entrywit: <br /> Transporter signature for exports only): D43 lewing U.S.: <br /> 17.7ransport4AclTmAedgTent of Receipt pf Materials <br /> Fe Transpoqer 1 Frintedffyined Name S; <br /> .unatureWin Day year <br /> < <br /> w Ce <br /> zranaPorter 2 Pitntedrryped Name Signature Month Vay Yeer <br /> t. <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ElType: D Residue ❑Partial Rejection ❑Ful!Rejection <br /> Manifest Reference Number. <br /> 118b.Attemate Facifty(or Generator) U.S.SPNBLNurrbqt <br /> Phone: <br /> 'S rbc SignahAa o-fAllemate Fadilty(of GeneraioQ Month Day Year <br /> lg.fiazardoLrsWaste Repo,�'ldanagemaiit VethndCodes([z.,codes for hazardous waste treatment,d*sal,and recycling systems) <br /> LU • 14, <br /> F20 Despated Facitity,D"r or 0pefa!or-..00rtiffcat*n of ruce'Jot of hazardous materials covered by the manifest except as 9placky Item 18a <br /> PMflL-dJ1ypW Kane Signature Month Day YeAr <br /> EPA Form 8700.22(Rev,3-05) Previous editions'are obsolete. <br /> LIES I G N A,T <br /> Fn FA.C.I LITY TO G EN EPJ13 OR <br />