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• 0 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) For,Approved.0Iv1B No.2050-0099 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST I CALOOD384M 1 1^888-5xMO 8 � F L E <br /> 5 Generafers Name and Mailing Address Generators Site Address(V different than mailing address) <br /> Oda �Pki�Il�ed Feeds LLC 3ttodttm <br /> 1 �unF� 8Fi�06 <br /> Generator's Phone: riag W M <br /> .♦♦Tr2��l'19�00n�er__I�Ompany 2me �t V.S.EPA ID Number /sem <br /> Ador Ad 11�ut Inc. CAMWOM <br /> T.Trannporlur 2 Gompany Name U.S.EPA NuNumber �/`WR/ <br /> U.J.EYA IU Namher <br /> 8133 r� Itii�b=209W I <br /> MA 87107 <br /> Facility's Ph.. <br /> ga, 9b.US.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> MM and Packing Group(if any)) No. Type Quantity Wt Nol. 13.Waste Codes <br /> 1NON RGRA HAZARnous wA <br /> o ANU 5TE,SOLUM ENT f OM G P 3m <br /> i ?UN1210.w9ste Pfthg ilk 3.PG1 D001 0035 <br /> FM <br /> X I DIY- i 31 <br /> 3, M ,. <br /> I <br /> I <br /> d. <br /> i <br /> 14,Speotal Handling Instructions and Additional Information <br /> 1) AGT47267 DCA- Dy/ <br /> /X s'S"c77� Prajwt Number 88838 DtYamelrt D103505 <br /> 2)ERM21t ACM7288 DOA- c,Cz- i x 3 Z-7 07- <br /> 15 <br /> T15. GENERATOR'S(OFFEROR'S CERTIFICATION: I hereby declare that the4,ontents of this consignment are fully and accurately described above by the proper shipping name,and are dasai5ed,P—kag,d, <br /> marked and labele&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 Vie Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(if I am a small quantity generator)is We. <br /> GtaeslOfferoen PrintadfTyped Name Ziqnature �r wntn Uoy yqor <br /> 16,International Shipments <br /> F- ❑Import to U.S. ❑E om U.S. Port of entry14 K <br /> Transporter signature for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> ,~„ Tra rter 1 PrintedlTyped Name ig�G en ay ear <br /> EL <br /> Z Transporter 2 Printedlfyped Name Signature Month Day Year <br /> 16.Discrepancy <br /> 1 Ba.Discrepancy Indication Space ❑ I t'uii Ruction <br /> Quantity ❑Type ❑Residue Partial Re'ecfion <br /> Manifest Reference Number. <br /> 18b.Attcmate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Faciti s Phone: <br /> W 18c Signature of Alternate Facility(or Generator) Monty Day Year <br /> 4 <br /> 19 Hazardous Waste Report Management Method Cortes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1 2. <br /> 3, 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item t 8a <br /> rOWF Name Signature Mon[ Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />