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0 <br />Please print nr Nnp IPnrm dpsinned fnr use nn elite (124frh) tvaewriter.) <br />Form Approved. OMB No. 2050-0039 <br />EPA rorA18700-22 Rev 1)5) Previous editions are obsolete. /-)<t.IESIGNATE[iFACILrrY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. Generator ID Number AA <br />WASTE MANIFEST �6} (7 ,y % <br />2. Page 1 of <br />1 <br />3. Eme/rgency Response Phone <br />/ 8"7�G'333' 4, l2 2 <br />4. Manifest Tracking Number <br />1 002260880 FLE <br />5.G neralors Name an Mailing Mailing Add ran Generators Site Address (if different than mailing address) <br />f333 ep Ydw+ev (td <br />Zode LA 9-5-2 Ll 0 <br />Generators hone: . <br />ran/Isporter l Company Name U.S EEPA ID Number <br />A <br />Adw,te.� dke te4 Yio�s ov� AR -000070S- <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />US Eaow_)y nJe edaf t+e <br />P.o• :svx raw 4s, �) ,.fries s. gealJ�y <br />�+ r "^� _ V '330010000 <br />Facillf 's Phone 0 3 33943 <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11, Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />WtNol. <br />I A)o rJ !C44A 4A ZA��fis?J 0( -F< oLf e) <br />r90 v -j <br />Z <br />LU <br />2. <br />3. <br />_Eli <br />- <br />4. <br />14. Special Handling Instructions and Additional Information, <br />,) 0.70 378 �) <s3'� Sgt, -8o1 <br />15. GENERATOR'SIOFFEROR'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 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 <br />Exposer, I cenBy that the contents of this consignment conform to the terms of the erected EPAAcknowledgment of Consent. <br />I curtly, that the waste minimizalmn statement identified in 40 CFR 262.27(a) (ff I am a large quantity generator) or (b) (if I am a small quantity generator) Is (rue. <br />Geralors/0erors <br />Put/Typed Name signa on ay ear <br />e) q lay <br />j <br />16. International Shipments <br />ElF- Import to U.S. ❑Export from U.S. Pon of entry/exit: <br />= <br />Transporter signature for exports only): Dale leavi U.S.: <br />w <br />17. Transporter AcknoWedgment of Receipt of Materials <br />Trans tlert Printed/fyped Signature C nth Day ear <br />N <br />Transporter 2 Pmued/Typed Name 5ignalum Year <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quanlily ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Market Reference Number: <br />186. Alternate Faci ity (or Generator) U.S. EPA ID Number <br />J <br />U <br />Q <br />r+• <br />Facilil 5 Phone: <br />W <br />life. Signature ofAltemale Facility(or Generator) Month Day Year <br />Q <br />a <br />N19. <br />Hazardous V4sks Report Management Method Codes (i.e., codes for hazardous waste Realment, disposal, and recycling systems) <br />LIJ <br />7. � <br />7.. 3. <br />4. <br />20. Designated Facility Owneror Operator: Certification of receipt of hazardous materials covered by the manif sal except as noted in Item 18 <br />d e SI Month Day Year <br />]Nam <br />/J"�i 12 O <br />EPA rorA18700-22 Rev 1)5) Previous editions are obsolete. /-)<t.IESIGNATE[iFACILrrY TO DESTINATION STATE (IF REQUIRED) <br />