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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number Z.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST {')*6 8 5 C MW I <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address)is v v v v J •r <br /> - *:+pyrt:ed f7CNrf <br /> Geneni Phone: >;,,- to BJ.�i 7Qi <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> i,Services Inc M A Q U .3 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Deaigni Facility Name and Site Address U.S.EPA ID Number <br /> GAD059494 :31 , <br /> Facility's Phone: (4 061441 DRS'2 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> and Packing Group(ff any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 0: _ UIi WASTE AEROSOLS _ <br /> 0 S <br /> x Q D l l�M tq r 352 D601 _ <br /> 2' 1824,WASTE SODIUM fie,1,x su'a <br /> 3. NONE,NONKRAHAZARDOUS WASTE LIQUIDS,MSEDOIL). (J <br /> N A 00 /W 000 <br /> / 221 <br /> 4. <br /> "E.". KFA HAZARDOUS WASTE 941 IDS.(OIL. ;52 <br /> ARSOR13ENT1,Ill i CC)37 /)#J <br /> 14.Special Handling Instructions and Additional Information <br /> 1l( T5`17W+ <br /> < �fii 39510 SSlJP EP.c,g15'f <br /> EE <br /> 'J. 33899X T S)� <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: Ihemby declare that the contents of his wnsg ant are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IabeletllplaceMed,and are in all respects in proper condition for trans <br /> i di o applicable international and national governmental regulations.If export shipment and 1 am the Pnmary <br /> Exporter,l cef ify that the contents of this consignment conform to the terms of the attached EP Acknowledgment of Consent. <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a larye anfity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatorre/Offerl PdntedRyped Name Signature Month Day Year <br /> J 16.International Shipments 7 <br /> F ❑Import to U.S. Export from U.S.. Port of enbylexit <br /> Transporter signature(for expod only): Date leaving U.S.: <br /> 17.Transporte-Acknowledgment of Receipt of Materials <br /> . Transporter 1 Printed/Typed Name -'y�-�— Month Day Year <br /> a / Signatu G/ <br /> -77 <br /> jr <br /> = TrenPtntedlTypme Signature spoter2 ed Nam <br /> 9 Month Day Year <br /> C <br /> H <br /> 4. 18,Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection <br /> 18b.Alternate Facility Mani est Reference Number. <br /> ty(or Generator) U.S.EPA 10 Number <br /> J <br /> U j <br /> Facility's Phone: l <br /> 18c.Signature of Alternate Facility(or Generator) <br /> f— Month Day Year <br /> z <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(ie.,codes for hazamous waste treatment,disposal,and recycling systems) <br /> t' 2. 3. - 4. H1$1 <br /> 20.Designated Facility Owner or OpemWr:CeNfication of receipt of hazardous materials covered by the manifest except as odea in Item 18a <br /> Pffi yped Name Signature Month Day Year <br /> EPA Form 8700-22(Rau 3-05) Previous editions are obsolete. .. DESIGNATED FACILITY TO GENERATOR <br /> ur�a.�i.- ;,TRIS fog 440 1 :. - r t .,�.,:w rite the -. ,.-.,.,.. ,x'449"1 <br />