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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 1 Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page of]3 Emergency Response Phone 4.Manifest Tracking Number SK <br /> cWASTEMANIFEST CW;�96t�Eai3%17f3 ; '"!' ; ' ��� ' (� SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ECEIVED <br /> 3..,1rt iSavnTte it <br /> 15 <br /> Generators Phone: ? —' R4 ^!2 17 <br /> 6.Transporter i Company Name U.S.EPA ID Number <br /> DFr' L U 2013 <br /> 7.Transporter 2 Company Name ENVIRONMENTAL U.S.EPA ID Number <br /> ' <br /> B.Designated Facility Name and Site Address R. •• U.S.EPA ID Number <br /> �500 LOKERN iiL"+F1:.' <br /> BUITUNWILI-04t 9 i,;A 32o <br /> Facilltys Phone: <br /> 661..-7',W2-6, :d.1 I ;y'7Y'r�4�'it7(57':1G��a <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pecking Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NOW, NPjN r4VRA WiZARUGU9 WAGM LIIN M,'S DM <br /> �- <br /> 2 3tuNE. NUN Ri RA HRZf!RD U8 W$181't if1i.IDi's, � P 291 <br /> DRY PAW" dWT;S"E m' albs), NJw <br /> 3. <br /> 4.' <br /> 14.Special Handling Instructions and Additional Information i ryry I��+ `� <br /> y'l°J IYI YJ C.SiJ ,.eB 'a an.. <br /> e4• HR. Eftlk"Ala NCY (5r1FE-rY-R1.,E :N) <br /> 116. 1GEA kAT SIO F OR' R I IC Td :'I ne'Fe f'df?cla a iha''ctfi "titft0n�g <br /> hlsnm$`pPe Nlyandaccurately descr!bedabdbe'tiy'ihe 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 intemalional 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 attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(If I am a small quantity generator)is true. <br /> Signature , Month Day Year <br /> z� <br /> an retorslOfierors Printe ype arae <br /> 16.International Shipments "" <br /> F LJ Import U.6. ❑Export from U.S., Port of entrylexit: <br /> z Transporter signature(for exports only):,,' Date leaving U.S.: <br /> w 17.TranspoAterAcknowledgment of Receiplof Matedals <br /> Transpor(4r 1!Printed/fypedN a Signature Month Day Year <br /> ._ <br /> QTmnsp der2 Pr r[yped me r ,N Zigriatune ' Month Day Ye r <br /> K <br /> H <br /> I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U - <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> rn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item Ias <br /> PrintedlIyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. - GENERATOR'S INITIAL COPY <br /> 1.)736,46M40324ML4 2) 7366090/404987`D <br />