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PSI_ SK Sitz.€€# 2r-355114A Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM HAZARDOUS _'rrt1,9 -x-,•...;F n....i. ,'i_ s 92 WASTE MANIFEST_ 10064135 SKS S.Generators Name and Mailing Address Generator's She Address(ifdiherentthan mailing address) ��17�D 4^E!i^9:t?i`5 b2.7L; Sihitll RWp:3.£k3ni; ILT:-1 '`1111s9y' Aye Generators Phone: `-t�'c�n'uFS 'fL",Ci`7 na 2017 6.Transporter 1 Company Name_ U.S.EPA ID Number ahF'ETV--i'.{..F.:�.N `xYif s k;h?i! s.�i.; ENVAbi4&k �rAC1}3> 7.Transporter 2 Company Name U.S.EPA ID Number rLEAN MR13ORS ENVIFGMENTAL SVC INC. 8.Designated Facility Name and Site Address M-FAN HARBORS E.N.VTt•tat(MENTA :F'.RVT-rus1 jN U.S.EPA ID Number P"o47 13 HfMIMPY 71 {t3N Fis,.t. NF 6914 k0-A-',+Fi...401c Facility's Phone: go 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WLIV01. ,±t I-l'i",412631 §3AF'-k'. mllhri p .5g rr-'6 I y..f : 4 j'-. ii 0)L'13 ,1:0Y41 5 440 i iti 4 O�54 Af, `l:: w w is P;t�:Su'-ter frt�c+sl,rj7tis dFl ,E�# T cltF-+- _ �r;=i 1.;�1,.. c..-.'s Nd �7.S,.p l 3. 4. 14.Special Handling instructions and Additional Information -pr PCi{Fa 7A'31�, .[i5 5 I:!-'+i�:''1i•':i •(T+=+: it(:,Iii�IE1=`t3� Jw1Z1�#1Eti' r"4 i^i€1 EhiE.r�R%f�C.Y �3�'$�f!%--rciti-.27cyy i�t� 1 Ii 1, - j,SfrTv 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aid are classified,packaged, marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulatigns.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent. I certify that the waste minimaation statement Identified in 40 CFR 262.27(a)(hl am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generalorsl0hemrs Printed(Typed Name Signature Month Day Year 1.• .� 16.International Shipments Y- ❑Import to U.S. ❑Expel from U.S. Pal fofentrylexif: z Transporter signature for expels only): Date leaving U.S.: w 17.TransporterAcknowledgmerdof Receipt of Materials Transporter 1 Printedlryped Name Signature, •""• Month Day Year S Q Thurriporler 2 PrintedtTyped Name Si9netura Momh "fDaY Year F- } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Relection ❑Full Rejection Manifest Reference Number. 186.Alternate Facility(or Generator) U.S.EPA ID Number zi U LL Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 20.Designated Facility Owner or Operator.Certification of raceipt of hazardous materials covered by the manifest except as nded in Item 18a Pdntedlfyped Name Signature Menti Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY ] tzi:€t1 fl=14 i'if47t jr ci:t/1 ':3V!t;;i•.