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<br /> Please print or We.(Form designed for use on elite 12-plich)typewriter.). Form A roved.OMB No.2050.0039
<br /> UNIFORM HAZARDOUS 1.GMMWD Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking NNumber ' e
<br /> WASTE MANIFEST ",r#d•.C'wV.,7:3'!e: �:''{t S} 5{;•4-*T'4:45 5)m•G tI.`2 0 a1 f�'e LC
<br /> S.Generwoes Name and MaNfng Address ` Generators SUe Add7,rass d different tun mal address .
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<br /> PywcalG. S tr,lfr�,i 1'"r'�aa•Y �t-)},r}+ .f� "1'd.,✓i4i.
<br /> Generators ne: - t .: )..,•t 'ti ,
<br /> 6.Transporter 1 Company ame ..v.,a•.•.r. .+ '+v 1' } 5 ,nr, .
<br /> U.S,EPA ID Number
<br /> 7.hanspater 2 Company Name ` U.S,EPA b Number• ;
<br /> Desig Fa•7 Name and SileAddr ss :.� ��„tIv,-I t r I
<br /> U.S.EPA 10 Numbbr j
<br /> ,11:
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<br /> 9a. •U.S.D'OTt)eicription,(Indudfng Proper Shipping Name,Hazard Class,ID Number, 10.Containero 11.lbial, 12.Unit
<br /> end Padstng Group(if erry)) No. Type Quangty 4Vt Not 13.Waste Codes
<br /> • 1. i.(j�)W kju� i!'�,j-S_��.i<CI'(i-�rjy,7 t..fP;tS.lt'<!i£J:S`fCf, t(I�ii':';•::r1iQ, ft.r`,
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<br /> 14.Spadet Handling Instwdfons end Addi Tonal irdormatbn ` t1
<br /> >wr�C„-:r•: 'tt:>t 1�.C«�� + . .�r�i'it�,".l"t� . .,..�. r+
<br /> ��i'fjjN j.r�„ti •r•...,,�.+e ,� ,.� F71'a��"tlMt 1 t �I..S:,+�'l^lll;I�. '•t�r +.o-y',•°,!� M•1(> '{��riy
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<br /> 15. GENERATOR'S!OFFEROR'S CERTIFICATION:I 11e101309dare that the contents of(his consignment am fully and accurately described above by the propaeshipping no-,and ore dessifled,padraged,
<br /> morW and lebeleWscarded,and are In all respects In proper Wagon for transport according to WIlcabie Intemallo ai and national'' t
<br /> Orper ,s'r,Ice*Dal the ponte0ts thh(s gavemmenlel regutaeons.tt export sh(pmertt end I am the Primary
<br /> consigrvrwnt conform to the terms of The attached EPAAdolowledgment of Consent..
<br /> I I:eft that the waste minbdzallon statement I&NIfled In 40 CFR 282.27(x)(If I am a large quantity generator)or(b)(If I em a small quandly gensrstor)Is Inre.
<br /> mere e a t ype ame. gne re y
<br /> moo ear;.
<br /> 4«('i!'s h;It;C.Ei9.:tf'tx:�'ll~•:i:?1 :1f1 f,'};{tr;Ii•`_�r�'r?t't�t'.��4�r" r•
<br /> 16.•ntematlonal SMpments t
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<br /> Import to U.S. '❑Export from U.S. . Port.of Antryla>�f:'"',N _
<br /> Transportere for exports oh Dale lea U.S.:--
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<br /> 17.TirdnsPor1wAdmowledVwtofReceiptotMatedals
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<br /> rte�l Primed Nameon ay• ear lier 2 Phrted/fyp Name na ore s" ) f , )+ a; Y Year r
<br /> 18.DBcrepancy. � _, ;Y •'r S- t
<br /> 189.Discrepantly Indica8on Space
<br /> Quantify El Type ❑Residue ❑Peru Rejedon ❑Full Rejection
<br /> [Facwws
<br /> 8b.Nbmale F Manifest Reference Number.
<br /> ad8ry(orGenerator) U.S.EPA ID Number
<br /> v
<br /> Plane:
<br /> 18c,%natureofAllemateFadiiy(or Generator) Month Day Year
<br /> 19,qszarr}}loos Voste Report Management Method Codes p.e.,codes for hazardous waste treatment,disposal,and(ecydmg systems)14
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<br /> 20.DWgnatedd FacAriy.Omer or OPe lrw Cerelfcekn of receipt of hazardous materials covered by the manKest except as noted In Item 18a
<br /> t ywName ,- Skyralura r '•.
<br /> f I MarAh• DayYear
<br /> '�.?- ... :fir•, '�," ,�;,
<br /> EPA-Form 8700-22(Rev.3.05) Previous editions are obsolete.
<br /> TRANSPORTER'S COPY
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