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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 N r 2. Par t of 3. E WAIMMUNTO <br /> 46 Manifest Tracking Number <br /> WASTE MANIFEST <br /> 5. g e tors Va w5dVailin res5ss,, Genergtols Site Address fifdiRerent than mailing ad fess) <br /> ,w�' 71p Yi!;75: 3:(tl3 „79.s' t Cd ,,A, rd 'vif5 dA.[;'7:1et #;yiw-q 473;ij3 <br /> Y7larar$€;1:san , <br /> too <br /> . 452,9 a <br /> °J54i . A4f1 •;Dlktiti <br /> Generatots Phone: <br /> 6. Transporter t:Company Name U.S. EPA M Number <br /> a9rrr;0xq+ la4as draser�awr+k:Y ic�psr&.e tra IFIRA t A'9.010a3 It `i"i 41t <br /> 7. Transporter 2 Company Name U.S. EPAIDNumber <br /> SR�raslgn�teAfrty Nagla�iM, SileAddress U.S. EPA ID Number <br /> f Will <br /> Wilt. '1# 4--iifa 0 AX,544P45d4pa ( liik d <br /> Fadi s Phone: <br /> 9a. 9b. U.S. DOT gesaiption (Including Proper Shlpping Name, Hazard Class, ID Number, W. Contalnem 11. Total 12. Unit 13, Wsale Codes <br /> HM and Packing Group Rany)) - No. Type Quantity WWoI. <br /> 1. E$cfx4— IEU;441 3iaauFax.si4lx'(ry t+�^:�agF.•ri N.Atbrel 4�iir.n45a#�: 'y1# flN;i <br /> o Wia.,fxair fiP1717�.iX� _ Pft <br /> YRN4 4g <br /> W 2• sFrsge- lilt"Pt,&t. k3fe: r wn4lfuiet3 WATi1;nS 1%09 * 9 f ia.Tr .r3 5 <br /> 14,specialHaS.X99:!niFlYl4endAdjpd ^„ <br /> &l4',1ti2�',fX YRX11Pi;!a;lE lV'.GJi6%i) liP. 7 47¢Pitls38 tabaEYY [:AF3iYd1kY>-i:N4tk �l Ilk” y � 2 2. rv !' !_- <br /> ;. yea ,�'^s1 ; Waarax^ itx. sae: 7.'Pal)w iT9,a�rtlSaaz� d nsati cs�gaxtr (nt' timwnrs�gFaryY tY4tE'F§:. .<:3; J.^Yt►`3YfFtici�d <br /> lis .) mWik6yf xcu4&; : i S:.Y.`N75d'A97:D'a ; 39YY ti•U&PU,4l3 / J'Lkr4 TioriiiyiDili sy wb'jt . <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents ofthls consignment are fully and accurately described above bythe proper shipping name, and are classified, packaged, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the alllched EPA Acknowledgment of Consent. <br /> I ceAfy that the waste minimization statement Identified in 40 CFR 262.27(x) If l am a large quantity generator) or (b) (M am a small quantity generator) Is We, <br /> Genemloesl0fierols Pdnted/Typed Name Signature Month Day Year <br /> 16. Inlemab'onal Shipments <br /> Z ❑ Impod to U.S. ❑ Export from U.S. Pod of entrylexiC <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> 17 0TransporterAdmewledgmarit of Receiptof Materials <br /> Transpoderl.Print1ed7Typed NamQ ' Signature Monty Day Year <br /> � - , / , � ` -,n 1. \ ' � V•` l � :1Ct_+'4 n. . r.,... t� " — � ! .: ) J r i <br /> za Transporter 2 PrinledRyped Name Signature / Month -Day Year <br /> 18, Discrepancy <br /> lea. Discrepancy Indication Space .Quant, ❑ Type 1:1 Residue ❑ Padlal Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 7 786. Alternate Facility (a Generate) U.S. EPA ID Number <br /> V , <br /> u Fecilitys Phone: <br /> ¢W 18c, Signature ofNtemate Facility (or Generator) - _ Month Day Year <br /> z . <br /> y9. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1. 21 3. q, <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manliest a c4pI as noted I Item 18a <br /> PrintedrTyped Name s Signature F Month Day Year <br /> EPA Form 8700-22 (Rev. 3.05) Previous editions are obsolete, GENERATOR'S INITIAL COPY <br />