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Please print or type.(Form designed for use on elite(12-pitch)typewrfter.) Form Approved.OMB No.2050-003E <br /> UNIFORM HAZARDOUS 1'�r1Ora ID Number 2.Page 1 of 3.Emergency Response Phone 4.W" re�"g Number <br /> WASTE MANIFEST ja o--M 3 3� 1 (S 10 — b �3 005232238 JJ K <br /> �] <br /> 5• ors N nd Maginy Generators Site Address(d d' than maifrng address) <br /> 17n <br /> -• deT <br /> A0ieS � —5%87 � CK k K1/1 � x <br /> Gerleratofs ate: S.EPA ID Number ` <br /> 6.Tmmporter 1 Company Named L <br /> Anm <br /> V«t7 GGA/ <br /> U.S.EPA ID Number <br /> 7.Trans#er 2 Company Name <br /> Mfl211Cadf, e aro�Ae A4ress U.S.EPA ID Number <br /> 63Ierr70 o• l3 <br /> FaalWs Phone: 6 — <br /> 9b.U.S.DOT Description(irnduding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tatal 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.Nol. <br /> tz 1 ON _ (LLt�4Z4 vs t�4S SOIi` <br /> Ne 2 <br /> b 3 urs �iv V <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Insuur¢ons an Additional Information <br /> 15. GENERATOR'SJOFFEROR'S CERTIFlCATION: 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 labeledlplacarded,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 /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAdmwledgmenl of ConsettL <br /> I certify ttnat the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large Quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera—W51 Herons printediTyped Name Signature Month Day Yeai <br /> 4am seponeJ65a l ✓ Ot <br /> J <br /> it.Mtemational Shipman ❑Imp.9 U.S. ❑Export from U.S. t of en exit <br /> ETransporter signature(for exports only): Dale leaving U.S.: <br /> OC 17.Transporter Acknowledgment of Receipt of Materials <br /> LU r� <br /> Transporter,11 Pdntedrryped Name Signature Month Day Yea <br /> C CL 10(01101 O <br /> sporter 2 Printedrlyped Nalhe SignatureVe <br /> Month Day Yea <br /> H <br /> 18.Discrepancy <br /> 1lla.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection ❑Full Relection <br /> Maniesl Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Faolity/s Phone <br /> Day Ye <br /> W 18c.Signature of Alternate Facility(or Generator) Month <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1' 2 3. 4. <br /> 20.Designated Facilq Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as Wed in hem 18a <br /> Primedrryped Name Signature Month Day Ye <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUIRI <br />