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Please Pflhl Or Mee.(Form desionod for use on elite 12- doh)M..MW I <br /> Form Appwvad.OMB No.2050-0038 <br /> UNIFORM HAZARDOUS 2.Pap I of 1 Emrpancy Response Prdm_ IN IN <br /> WASTE MANIFEST DI*x" � .. —,, - <br /> 1"OUr,"7147 JJK <br /> Gonena&a Phonc. (I. <br /> y <br /> V w <br /> 13porle,1 GeV=Nems US.EPA ID Number <br /> 7.Trarsparw Z Company Name V.$.EPAIDNumbw <br /> 6 Designated Facility Nam and SbAddreas U.S EPA 10 Number <br /> i.:- <br /> Fad k(a Phone: <br /> 9,. 911,US DOT D89WOM(11duft Proper Shleft None,Hazard(dhawa ID Numar, 10.Cmsywe 11.Total 12.Net <br /> HIM &IdPdddn9(iinWP(1WW)) No. Type Quentity WLAAA. 13.Y1NN Codes <br /> 2, <br /> cD <br /> 3. <br /> 4 <br /> 14.S=W Handino Grudom,M U=Infemanon <br /> 4,,i-�! I 3} I$ .7 <br /> 15 GFNERATOR'SIOFFERORSCERTOCATIDN: lh&v4dadmOWthoomMatoofthisax"nwnwefdymd ecou"LaO desedbed alewe by the proper ShppM namig,and are ciassilled.pacWed, <br /> marked and labosado"dad,and gas In all noWce;In MW wricbm for transW flocel to applicable hwmdOnBl end national govermeental regota6tars.N exparl shipment&M I am One Prmpry <br /> Exporter,I MrOff am mg wasms of We ccmignmam co"M to 06 tam at N arwidd l Admamlodgmmit of Consem <br /> I oartlyftHhe mble rrinkni2atlon aWt~WWAMW In 40 CFR 282127(a)(f I am a bqR quwdUy gametes)nr(b)(di am a yrnal;q,,shy gaftnft)le We. <br /> GenerawealOffemes PWodnWW Nam Sunah" Mmth FiaY—yw <br /> 16.International Shipmras 0Innpr1IU..5. Elaw earn U.S. Fort of antrylexif <br /> 3 Transporter ❑ <br /> signature Ifor expris 0*). Dalt Waviny U.S.,__ <br /> Ce <br /> Transpartr I PwintudIly7lNum Gonghua <br /> Marm Day Year <br /> 7quporter 2 Pnrdo(YTypDd Nam SIgmWItl fdpnmua—Y, Tear <br /> 18 Discrepancy <br /> las cr <br /> Disapancy IrdKOW SONOR Fl othy FITYP. r]....g . ❑Partial R.011lon El FW,R*dm <br /> Mwilest Raferwm Number. <br /> 18bAlteirlate FaCtlity,(w GwWstDr) U.S.EPA 10 Numear <br /> F.dity'sPhOrm, <br /> Jar.SWwWm ofAhemes Fedity(Or Gergurator) <br /> Qw <br /> Month Day Year <br /> S2 19.Flazurdouat Mato Report Management l Cods fl a.coda forhozrdomwasla,asamnant, <br /> 20.Dodrpolcd FxWty Oomrcr Oponmr:Cerefloaden of recaPt of huwdwn ma4imple w and tot In*mrant woupt as ndAd In Rom Ise <br /> W,�ypd N-ne Swanuna on year <br /> EPA Form 8700-22(Kfpv,3-W) Previous edtiorre,are obsolete. GENERATOR'S INITIAL COPY <br /> :WIDbJ 9T:9T 0102-2-030 <br />