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Please print or pe. (Form dews' edforuseoner-ite.i2-otch)typowrft4 <br />UNIFORM HAZARDOUS 1 Generator ID Number <br />WASTE MANIFEST <br />enefatoes ame and al Ing d rase <br />Lion- liy�; :,?r(t$u�r++;tta.,t��!?�;_si:l.•t.' <br />enaratoes Phone!, r• p <br />rensporter ompany ame <br />xi(fi s�t;t 9 CI-Awkto Tito, <br />� <br />I <br />—9810T 3. Emergent R14. <br />Form Approved. OMB No. 2050-0039 <br />Emergency Response Phone an t Tracking Number <br />! "x..8,F1 F1 <br />3.. <br />!.'atF{lG6iw? ri41 <br />PO siu ..� , j i >ats wr �.� �•,�t, MY? <br />B),Ok ley, u' tr <br />rftone. ,'� ,., <br />cdptlon (including Proper Shippng Name, Hazard Gass, 10 Number,10. Canta'nersp Of any)) it. Tots' 12. Unit f 3. Waste Cordes <br />Na. � Quan6ry <br />�iit:9'�^��3aM1Y �i�atilNs se tkAil:3 tR p Pi <br />"35-7-7—, <br />... Wt Nd <br />13. GE ked and inbele iscard S CERTFICATIQN: hereby declare that the contents of this consignment are fully and accurately described above the <br />marked and 7ebeledlpacarded, and are in all acts in �� r'- �� and are classified, packaged, <br />, <br />reap proper t condition for transport choordlrg to applicable ant of <br />tioeei and national governmental regulations. if export shipment and t am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I candy that the waste minimization statement identified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) Of I am a small quantity generator) is Into, <br />enera or s ere arm yp ane n e <br />� r Month --- <br />16. <br />16. International Shipments ,y (! U. <br />❑ Import to U.S. ❑ Export from U S. Pori of entry/e>at: <br />Trans1 rtersf naturerexportaon Dateleavn U.S.: <br />17. TransporrtarAdmowlleedgmant of Receiptof Materials <br />relnsporter t 7. A , ) y e rare ! • () <br />Name <br />in', en 4 y y eajj <br />r/ bi w .j 1 t �_•r r �• 1.l �' r (1 •�M' �i i f, l i..!'<.ti r 4'.. r ?moi. < r�. "l''1 ( ) 1 I (f �.4. <br />18. Discrepancy <br />18a. Discrepancy Indication Space <br />❑ Quantity ❑npe <br />❑ Residue ❑ Partlal Rejection ❑ Full Rejection <br />Manifest Reference Number: b •r <br />U.S. EPA IO Nuor <br />J i <br />,% 19. Hazardous Waste Report Management Method Codas (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1 2. 3. 4. s <br />20. Designated Facility Owner or Operator. Codification of recelpt of hazardous materiels covered by the manifest except as noted'In Item 18a <br />PdntedTyw Name <br />1 Signature r. <br />EPA Form 8700-22 (Rev. 3.05 Previous editions ere obsolete. <br />V <br />A <br />i17Ts i TC•�lllnT�/r�41 <br />Ionth Day Year <br />TRANSPORTER'S COPY <br />