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Pie se print or type (Form designed for use on elite(12-plMh)typewriter) - Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number . agelof 3Emergenyy Response Phone 0.MarydHa�s}tTrzckmg Number ]]_ `IC[� <br /> WASTE MANIFEST .., �? g ;i z 10 F '—'tpG tc`7 d .. i;;;UJc. <br /> !;! '-' YES <br /> S.Generators Name and Mailing Address Geftai bileAddress(d diarent than mans address) <br /> r <br /> TO !7OF,.'_A 5.20` <br /> Generators Phone:20d S1:�r01J1-? - <br /> 6.Transporter 1 CompanyName .U.S.EPA ID Numher <br /> 0 51 3 1 3 6 B <br /> 7 Transporter Company Name U.S.EPA W Number <br /> M"ETIVIROIWENTAL SERViCPES !A. T O 0 0 6 2 4 2i $ 7.'... <br /> 8.Designated Facility Name and Site Address r U.S.EPA <br /> trEt,�.{.A tS TcCHPtiICc.l_SOW UTitridS ID Number <br /> 1704 W.ARST STREE-'i <br /> Facility's Phone: 426, 334-f5!V7 AZUS'A,C#..' A970'2 v A 0 G Q 3 Q 2 2 G _ <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Totai 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type 0uantity WtNol. <br /> z <br /> tgl' 1P1-R.'F,A.HAZA.R.O?7U>ifl,''iTELIt]Ul t,(lir'tit.SLiJQG aa{ <br /> 00470 <br /> z 2WOPJ-RCrRAKAZA.hDO1JSWASItSOL'D,D1NXSt:iJDS) 352 <br /> w <br /> 3. <br /> r <br /> 4. <br /> . 14.Special Handlingln*wtons and Additional Information ER Ser-ice CO1t2Ctiew by VESTS -1- 1)1tb`'!.0033 i.:REG-4.ATEP'.(H'DIAti) 9 X 55GAL. 21 <br /> \ W100a'.2A:A U-;_iE9cUEi(3PL2X66CAL <br /> 15. GENERATOWSIOFFEROR'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, <br /> marked and labeladlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify ihatthe contents of this consignment conform to the tenors of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)oro)(if I am a small quantitygenerator)is he. - <br /> Mantlt Oa .. ear. <br /> Generato Offerors PrintedRype4d',N}came Sig re / y r Year. <br /> AL1 t <br /> r 16.International Shipments Ll Import to U.S. <br /> ❑Exportfrom U.S.' Port of enhy/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> It 17.Tran spoi Acknowledgment of Receipt of Materials <br /> Transporter 1 Printe irryped Name Signatu / Month Day Year. <br /> O FRED Ta)E •Eh4.4;1 1 ? 1 <br /> a <br /> z Trans "rince yped Na a Signature., - Month Day Ye r <br /> H ( <br /> 1B.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type - `.El Residue .' 0 Partial Rejection ❑Full Rejection <br /> Manifest Reference-Number <br /> 18b.Alternate Facility four Generator) - _ _ U.S.EPA IO Number <br /> J <br /> u Faclliys Phone: . <br /> w 18c.Signature of Alternate Facility(or Generator), - Month Day Year <br /> =Waste Hazardousent Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20. ' rated Facil'dy Owner dr.0perator Certification of receipt of hazardous materials covered by the:mar)ir ex ` I as noted in Item 18a <br /> N(a .,^r� oil AQ bo Jao"idhidyf <br /> EPA Form8700-22(Rev.3-05)Previous.edibons.are obsolete. DESIGNATED FACILITY TO GENERATOR <br />