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4"kw" F t <br /> Please print of'pe.(Form degignad for use on ante(12-pitch)typewriter'.) , : .Form Approved,OMB No.2050 0039 <br /> UNIFORM HAZARt70US 1.Genera�r 10 Nrmer Y' " ......2 Pie 1 of 3.,Fmergency Response . 4.tdarrifest 7 cfdrsg Ndrrrber i <br /> WASTE MANIFEST. CAI E3t37iCftia dJtJK <br /> t 5•Generator's Name and Mailing Address ' AY, Generators 3rle Addr {d dOferrdthan mailing address) <br /> "- OM Mot 10 jTraoy 141TOIF# t � �� <br /> slootct.m.O X31 U t LISA <br /> aA rate' pt <br /> s I <br /> GaderatofaPhone: - :>• .:;„. <br /> 6sporter Company NaU.S1PP 10 Number <br /> ” ani3tI.L. me <br /> E=f�PdtFtfttdtdf.�fi+dt",�iL^sa �� � C, s� .. <br /> fi , sem`r • <br /> Transporter 2 Company Name U.3.EPA IlTNumber r <br /> + f41 �ta ` at1 _ Cyt: us.EPn b Numbe <br /> 22 <br /> KM <br /> p3S7U'2 <br /> , Fags PIM W. <br /> gb,i1.§` dwalp8on OWuding Prop®r Shipping Name Hazard mss,tp Pru <br /> ` ` 10 Cadakr, 13Naste Caries <br /> 9a• ng x4a.D 11 Total;: 12.Unit <br /> ;FIM end Packfrs�Group(!f arry) . �, Nom T 4uanAty WtNd <br /> F <br /> 23 <br /> i 2 Ea 4 <br /> c i .. v, .. '°fix!'• .q�. J � ..r°° 9... I'-tJ <br /> $ �� �Yk <br /> 3. <br /> 4. 's rte ' <br /> fir <br /> 4.sper )R-di rg lnstnidlars and Additional lnfona� 4 l <br /> � 1� '•` rw � �'• b t' is _� .ay. '^' '� ''3a <br /> .: •.�, _ <br /> 15.'GENERATORWOPFEROWS CERTWICATiON:I hereby declare that the cwirtetjts of tai= frr8y and a«aualety,desdbed above by.the proper stdppl tame,aid are dassified,packaged, b h <br /> marked ac d tedlpl arded,and are in all reapecls ar pmper r indlff4n forir ssporf aawr �Ta e E Wgrn ford and Xationat go0*t, latrans.if export shipment and i am Ore Pi rp <br /> ..Exporter,l p�rliify Ifiat cflntents•af firts consignment canforml the(erms oFOre att d EPA1ldkno�edgment of Consent.: d <br /> !certify tf�f Ore wa iatlon smtetrieirt identified in 40 CM262 27(a)(ff f arr a Targe t�Yga�ata) quantity g )is iNeY . <br /> GsnerafofsaDffarofs _ AfaO,e ti st ,awre Month DayYff <br /> r International s!prnents ❑Import m U.S. D Export freer u.s. Pat of antiyfex <br /> 4;• <br /> Trar6orter signature(for export8 only): Date leaft U.S.: <br /> .17.Tra.n .0, Adsnowiedgmelt ofRew(ptofMaterhdls <br /> F <br /> yped Nwe Signature p Month p Year <br /> . a Turns <br /> TrarsSportar 2 Ptbrtedltyp Name Signature Month Day •'C Year <br /> 18.Discrepancy.. <br /> 18a.Disaepaney(ndlcatfon Space <br /> ru ❑Quantity ❑Type ❑Residue t,.: ❑Paitiai RajaA ❑Full Rejecfiat?; <br /> Man'dest Reference Number. 4" 4 <br /> 18bAOettiae',a (or Generator) USi <br /> I If <br /> v (ice <br /> ( . FaaTiys Pharer E <br /> 18c.Signature o Alterhdte•Faaliry(or Generator) D Year <br /> f a' yn '� <br /> 1Ef . , <br /> 19.Hazardous Wasted'get Management Method Codes r.a.,nodes for hazardous waste-treatment,disposal,and mgdhg systems) P. m <br /> 20.Designated FacBiiyy OwnOwi&Ir Operator.Certification of receipt of hazardous materials covered by Ore main"eai�pt as nded#n Item 18e <br /> P' ped NameMonth Day Year <br /> EPA Form 8700-22(Rev.3-05) avious.%diUons are obsolete. TR-AN SPORTEF y - <br /> �0. i <br /> x <br />