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Sep 04 09 03: 19p Lindsay Schwager 2099523389 p. 9 <br /> Form Approved.OMB No.2050-0039 <br /> Please print or e.(Form designed for use on elite(12-Ditch)typewriter.) 4.Member Tracking Number __ <br /> +} �{ �g 2.Page 1 or 3.Emergerwy Response Phone (+ p C <br /> 1 m .L. 15486464-274U xi ..c I l7Uf <br /> UNIFORM HAZARDOUS •� � li �7- • <br /> WASTE MANIFEST Generator's Sge Address of...... hart mailing address) <br /> 5.Generelofs Name aril Making Address <br /> PARA 115E rT & BOAT RFP <br /> t9(!R"" B ?1�iCC7 ii?l <br /> ti)•QZil 4-'A95201 - U.S.EPAID Number <br /> 6. minora Phone. <br /> 6.Transporkrt ComParry Name �- � � p�Iilii0�3f"iL�f 6 § <br /> },jg(`.y(`{111(T SethCe Inc US.EPA ID Number <br /> 7.Transporter 2 Company Name - <br /> U.S.EPA ID Number <br /> S.Designated Fad kry Name and Site Address ,AliRAll010i)! 751 <br /> as Reli'40!frrf tiF'i':1f? ih!. Tl1F i�.6I Si <br /> jl7" j-Ie(72R c.+l - <br /> = �'In. t/V1 %j,l[�•'.;s i�..CRf..;.a.;..7V'!Afs <br /> 10.Containers 11.Total 12.Unit 12 Waste Codes <br /> ga. 9b.U.S.DOT Oesaip on tinProper$hipping Name.Hazard Class.ID Number. No. Type Quantity WI.11101. <br /> and Packing Group If any)) _ <br /> 0 1Non-RCCA <br /> i <br /> 14.SPedal Hand' instructions and AdABonO Information E.r Ti. ?.: tai1 <br /> �71/P:.yi i•'f'pCBt:C[Vf C1i}tj71T1�:kT1e1�VL'WPii. i � iy3..;' 11�C)xiB'1-114". <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: Ifterebydeclarethallheoantents Mthis consignment are lolly anti accurately desedbed above try Ute Pre Per shrppingrame,and are dass8�ed,packaged, <br /> marked and Iabeledipjacerded,and are in all respects in proper condition la transport according to applicable Intermittent and national governmental regulallons.If export shipment and I am the Primary <br /> Expands I certify tial the contents of this consignment conform to the terms of the attached EPAAck lmyledgmant of Consent. <br /> wNfy Incl the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator?or(b)(if I am a small quid generator)is li% Mon Day Year <br /> Gel�eratol,UOffgWi print"Typed Name <br /> 16.International ShipmentsImport to U.S. C:1 Export from U.S. Pon of entry/axle:_ <br /> t- Date leaving U.S.: <br /> S Tm podar signature(for exports only): <br /> rY 17.Transpoda[ACIM Medgmanl of Rece'ryt of Materials - <br /> Skgnalur9' <br /> Atondr Day Year <br /> KTransoo 1 WWedQyped Name _ r `M t <br /> y r - Signature Tdonth Day Year <br /> z Tre orel2 Pdmed/TYPed Name ` <br /> a <br /> rY <br /> ♦ 18.DisaepancY <br /> IType ❑Residue ❑Partial Rejection Fuk Reaction18a.Discrepancy,indication Space ElQuan6ry <br /> Manifest Reference Number: <br /> U.S.EPA ID Numner <br /> 18b.Alternate Facility(a Generalor) <br /> J <br /> 4Monty Day Year <br /> LL Fadln�/s Phone. <br /> GW lac.Signature of Allemate Facilitydr Ganemtor) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management McNod Codes G.e.,codes for haaartlous waste treatment,disposal,aM recycling systems 3. 4 <br /> W 2 <br /> 0 1. <br /> 20.Designated Facility Owner or Operator:Cerdflc'bon of receipt of hetamous materials covered by Vre manite t re pt as natetl Ilem.lae 1 Me Day Year <br /> l ^ ) o <br /> Plintedrryped a(ne <br /> EPA Form 8700-22(Rev.3-05) Prev s editions am obsolete. ra.�at �: E}�a�f:ik ',k 7 C.E:eyFr�,:,- -,( <br />