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74 <br />nesqa <br />pirtworryW, lirorm oeslgirlea <br />tar use on elite (1z-pitMtypewriter.) Form Approved. OMB No, 2050-0039 <br />UNIFORM HAZARI - )OUS 1. Generator 10 Number 2. Page IV 3. Emergency Response Phone 4. Menifest jrVjIng Number <br />WASTE MANIKST n7E <br />0 <br />0,18M -nz-)�724,5 U d FLE <br />-7 <br />5:GeneratorName and Mailing Address C%erators to Address (If -different than mailing address ) <br />Traq 'i , iVj �t i ifr; e, + bm IT '.0.4 iA," i "L 1. <br />4199 G ibr %1 Ner 0. <br />ftc-zk,,�m 0A 05LV)(-; <br />Generator's Phone': <br />6. Transporter 1 CiApany Name U.S. EPA ID Number <br />7. Transporter 2 Company Nam U.S. EPA 10 Number <br />8. Designated Fadity Name and Site Address U.S. EPA ID Number <br />44m,"10-dk * �hct(-JiC4 Treotwift <br />Fecilh es Phone: <br />98. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, IDNurnber, <br />10. Containers <br />11. <br />1. Total <br />12. unit <br />HM - <br />and Packing Group (if any)) <br />Quantity <br />willvol. <br />13. Waste Codes <br />No, <br />-Type <br />0 <br />Lu <br />Z <br />2. <br />LU <br />129 <br />3. <br />4. <br />a <br />14. Special Handling Instructions and Additional information <br />7 <br />15. GENERAMR'SIOFFEROlr$'CERTIFICAPON: I hereby declare that the contents of this conalgirmentare fully and accurately denribed above by,thei proper shipping name, and are classified, packaged, <br />marked and IabeWpjac&1iid; ah&pre.1hall respects in propero6difion for transport according to applicable international and nationalmenial regulatiors. If 6xPool s I hipment and.] am the Primary <br />Exporter I certify that the contents"aft wrisighment conform to *.terms of the attached EPA-Acknowledgmg%q <br />ihi�tqgns6rit; <br />waste rnomizAton slatementidentified in4QCFR 2B227(a) (If lama largkquanthy,gerierft) or (b) -#ffiall quantity generator) is true' <br />, Zeno k9.fferor!sFInto cIrTypAdNamo------ Tignature-7- Mon!t <br />ft , Day I Ye <br />..t16. <br />Intematioral 311!pmeO <br />El irrl to U.S. E1.Ex[xjrt from U.S Port of entrylext: <br />Trans oiofterli"stun for ez orfs aniy): Date leaving U.S.: <br />IX <br />Lu <br />f7. TrarisOcrterftnowledgmerl� of Receipt I of Materials 11 <br />ame iw>t fe A Month <br />J <br />�'YV/ <br />Z <br />-X <br />Tranipor!02 PrTntedTTypea Imunio Signature' Month pay Year <br />18 Discrepancy <br />18a. Discrepancy Indication Space ❑ ty Residue ❑ Partial Rejection QT02 <br />Quantil Fu 11 Rejection <br />jel.e <br />Mardest Reference Number: <br />I 8b. Alternate Facility (or Generator) <br />U.S. EPA ID Number StY <br />17.111rs Ph.: <br />18c. Signature of Alternate Facility (or Generator) Mlorth Day Year <br />S2 <br />19. Hazardous Waste Report Management Method Coded for <br />(i.e., codes hazardous waste treatment, disposal, and recycling systems) V. 1. F-4iLw <br />. Tlu <br />T2 . . -J3 <br />I --C- <br />' L - I <br />4� - <br />a <br />I . L -. . . <br />,90.QeiighatedLFacility bwnerorLOperator:'CedfloAtion*6(.re ha7ardo iplof us inisfariiis covered by the manifest except as noted in Item 1 Be <br />Printed�ypetl Name Signature Month Da; Year <br />1:2 P Ir <br />EPA Form 8700-22 (Rev. 3-05)< Previous editions are obsollete. <br />DESIGNATED FACOY TO GENERATOR <br />