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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Nurn or `/ WASTE MANIFEST �.,.� „"„ 0 0 5 0 J. } 8 VES 5.Generalor's Name and hiailing Address Generator's Site Address(if different than mailing address) (Y>>20-3`.v-2 GeheraT ii sPh'orie:'` 6.Transporter 1 Company Name `'" U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number L Facility's Phone: ri i t i a 9a. 9b.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WLNol. 13.Waste Codes 1. LV-P Srfl L,1 TJ D,(US-10140T0R. 227 w - z 2. w �ti.?:_T.i''v'v FLui tirf�-rSri JTrIT� _'r .L'7.rl1 ii SCliirr>i ''•? (D .._ yl X5,1 ti_ - -• i': r / Li+ j''tt atd�t4 111 tai t. {� �tic.{l 4. 14.Special Handling Instructions and Additional Information �fZ Sp vke CkadrfleU.b.v 1,T'1:T'S 4- 1 ";xe':?t"iralttil l? rvfi16-j17&iW-VN-rkC 3•kJ7ub311ei;.ilf. 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I ce08ty that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I am a small quantity generator)is We. Generatoes/Offeroes Prinled/Typed Name Signature Month Day Year 16.IntemagonaiShfpmenls i 1:1 Import Impart to U.S. Export from U.S. Port of enlry,;exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAc4noMedgment of Receipt of Materials w Transporter 1 Printed/Typed Name Signature Month Day Year At { I ""A Q< Transporter2Printed/TypedName 1 Siynalure-.- ---"` Month Day Year 18.Discrepancy 18a.Discrepancy Indication Spare ❑ Quantity ❑Type ❑Residuej ❑ ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U u- FaciliVs Phone: Lo 18c.Signature ofARemate Facility(or Generator) Month Day Year a z N19,Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY