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i1�.11"GIiY►'-�1M10t RM" to I Aganey"` <br /> /lari Approved Ob!lap.2OW--0039(Ez01r•t 9 <br /> PI•sea prk R taps,. (i°am daa4red M useon er .,yhM fYpeaT8er1. - SaRaatrrq CdleraM.�: <br /> UNIFORM HAZARDOUS Gans"wo/a US EPA D ft. t f Docurnwit Notion&by <br /> ed <br /> ]Q WASTE MANIFEST le not requeral law3. GwamtoYa lama arch Malting Address . �,. . <br /> P0 (VV yon{ Pit f- uoi- 9 4 rip 14 <br /> 4. Generator's Phone"I 7 7 - <br /> �$ 5. Transports, 1 Company Name d. US EPA D Number C. Asia Trart•puriss s D <br /> n 3 C 1 / ' D. TroospoNa/a Pheta <br /> \arm— 7. Transporter 2 Company Nems, 8. US EPA ID Number E SWs,Tnnapurfar's D <br /> Jm _ F. Tranaportefs Pana <br /> Pimm 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Feci ity'e D <br /> 7 U ZZ �Ff'1�+Ps FjTI 1 I tir H. F a Phoma yw! <br /> J` r. i c):7 ICIAIDIttltl 171711 <br /> iM 1 Z.,Contamera 13. Total 14. L <br /> •ae Ow 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> J� No. Type VA/Voll <br /> J U e. Stas, <br /> 2Z Z4 1 <br /> G EPA/Othw <br /> E b. Stale <br /> N R <br /> .�� T EPA/Other <br /> Jr <br /> R C. <br /> State <br /> (�$e R <br /> EPA101hor <br /> it. State <br /> V �AyOWer _ <br /> W i. <br /> 0 J. Additional Descriptions for Materials Listed Above._ K Nandi Codes for Wastes Listed Above <br /> Ix CL <br /> a _ <br /> O <br /> F 15. Special Handling Instructions and Additional Information <br /> 2 <br /> W <br /> 2 <br /> H <br /> J � <br /> V tB. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the connote of this consignment are fully and accurately described above by proper shipping name <br /> J and aro classified,packed.marked,and labeled.and we In all respects In proper condition for transport by hlghwsy according to applicable international and <br /> Nnational government regulations. <br /> ¢ M 1 am a large quantity generator.I certify that 1 how a program in place to radia the volume and toxicity of"ate generated to the door"I hew determined <br /> Q to ba economically practicable and that I Mw selected the practicable method of treatment.stamps.a disposal currently available to me which minimizes the <br /> Present end love threat to human health and the smkonmem:OR,M I am a smell quantity generator.I have made a good faith effort to minimize my waste <br /> U generation and select the beer waste nswagamanf method that is available to me and that 1 can afford. <br /> Z <br /> a Printed/Typed Nome 91 ) Month Day Year <br /> ¢ C <br /> w <br /> w <br /> T 17. Transporter 1 AcknoMed9s,nent of Repept of Materials <br /> R <br /> A Primed/Typed Nam Signa rs y Month Day Year <br /> N f r <br /> S <br /> w 0 1& Transporm,7 AEknowunigeassive of Receipt of Materials <br /> T Printed/Typed Nome Signature Month Day Year <br /> U E <br /> 2 <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or pwator Certification of..pt of pa7F-o materiala covered by this men of ax tae not m Mem 1 <br /> T <br /> y Piriii,411/Ty dNem Signature Month Day Year <br /> DHS 8022 A(1/88) Do Not Write Below This Line Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAY' <br /> EPA 8700-22 <br /> (Rev.2188)Previous editions are obsolete. <br />