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Please Print a <br /> type.(Form desKJled f0fIse on eNte(12-pifdl)Typewriter.) <br /> UNIFORM HAZARDOUS 1.Generamr wµmbar Form Approved.OMB No.2050-0039 <br /> =MANIFEST Fnar�ncy Raspnne Phony 1.YaNfesi i Nwnbsr <br /> B.Genembfa Narre yq d. 000 1744 JJK <br /> t Address(ddAfererR don P'�"n , <br /> �n�E¢IAM QFC �+S 64pZ11 SRJc�"laU 04a� --^^�� <br /> araiXsar I Cm <br /> 6.Tca <br /> rareputar car"". <br /> ill V I �' us.FPA w NunOer <br /> T.T2nsporter Company Nene <br /> C U.S.FPA ID NLuimbn CJ <br /> 8. F and sileAddressGp�y� c Ct -C'U'0 2 S[r 2 Z <br /> 1 10 s b 1�3-j U.S.FPA w niumber <br /> l7 (4r� sr <br /> t or�-t 6�vc�! ch 5''Zq <br /> - <br /> FacNly's Phorn: G� nr' <br /> 8a. 9b.U.S.DOT Desayreen(ncurip PMWAShppirn Name.Hazard Class,w Nurno., Q-2 " (4" '`�('�} <br /> /07 <br /> NM and Packingcxap(darry)) 10.DOnfdeple <br /> 1. . l 2 No. T Ou Tntaj 72.Unit 13.Waste Codes <br /> UN (0186 Via"611, YW NY WtNd. <br /> �(� 111 IltA�aot �TASautt47�v� S. ) O'Z 1 <br /> 2' .oar <br /> In, <br /> 3. nsu m <br /> .tor ll(I'1T nor a1T Slvpm NAND iN <br /> .5 MYri T(,❑I 1 1( AND SIO <br /> h i`FIx �_(VS`YTALP JITQt0.l'ATS2'Nr ppT01UC JOPF P11R.nlFF <br /> I\( .ATF.S dice <br /> 4. - l'A IFYry I'➢C 'ANTL-rTlACllny p!'9 <br /> 'F1cfA(TS TOA �'-rlllAliO,YS, al UY 11 riKw"'; <br /> i Ill <br /> AOCollDwgy UYFY1 "Iii RFtkkEY(}DC WASFY a 'vEk rcry i:As ui lFUE{ O r <br /> 14.Special H&WAV Imbuc4ms and Ad68orA kdanation w. I� w sDti Itna ssak _ <br /> OMA&S10 U 12lt'��Nt Oktit2 <br /> 15. GENERATOR'SwffEROWS I F 111 CATN1N:I frereby dectara yet die cadents of drs <br /> :'-P}trpad and Wale&03crded.and are n a4 Map"in pmpOrexgmon brbarmpon Wragrxrarrt ere gAty aMaavmletyikscsbad abrne hydra proper ehippeg name,orb are classified,pal'lrz9aq <br /> > dYis auclPsrard rpdpm tothe tamsdlhaatledred A I t 9oveeter <br /> nd'al regWztions.IfeW sMPment red l am the Primary <br /> emds PrbrlCyped Name Mbfifl148237(ej(8i9ni°'kg¢9aaMii`ge rlar asnaFpenMygeayaprjiabae--- .. <br /> Year <br /> ❑hpodbD.S. ❑ExWrfm US <br /> . . K <br /> iwnspodar aignahae(ixesporh aNy): Port of /exit <br /> 17.TmltsppisrAtlnwsladpr,ard ofRecep(dA4Mdak Dale leaven U.S.: -- ----.._._----------- <br /> Transporter 1 Prini%vTyped Narre <br /> a0 - Sigrature �. <br /> Month Da Year <br /> G T 2 PdnWyped Name /'' r � 3 ///Y <br /> Month Dal Year <br /> 18.Disc,ep"y yv(�c�ti 2 I �/ I /Y <br /> l ,8a DiscroW"tr icebm space LJ clarday Type <br /> LJ Residue ❑Partial Rejection ❑Fud Rejection <br /> 18b.Aherne,Fanny(or Genraiy) ManAesl Retererce Niyrylar <br /> 'J t15.EPA IO Nwnoer <br /> 'U <br /> Q <br /> LL Faddys PMna: <br /> 18c.Siglabra olAller aia Faddy(ar Gwrw <br /> z Month Day Year <br /> H99.Hazsly(oPy Waste Rep'oM1 ManaBemw9 M�hoO Codes(I.e.,oades far hazardous waste bea6renl, <br /> dkposy,argracyrlsg sysWa) <br /> 4-- <br /> 20 Dasigaled Faddy peyrar O2erabr Certification afmceiptNhanrdous materials coveredby the panttax las rated' Morro l8a <br /> PreeaNTypagName ,' <br /> sign <br /> Y - :l ✓!i Month Day Year <br /> EPA Form 8700-22(Rev. Previous editions are obsolete. <br /> - <br /> ' <br /> DESIGNATED FACILITY TO GENERATOR <br />