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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-003$ UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 000358785 F LE 5.G erator s Name and Mailing Addres n t de Addres (if different than mailing address) fan IS u.It ATTM. himba WrO f) 3(oayuin Household 14am daj vk� 1B10 EUkA FaCtUfN Genora15sl ray# C ,q�a� `7 P-A�r-me-foistr�'6+ 6-Transporter 1 Compan Ne U.S.1:PA ID Number am 6 7,Transporter 2 Company Name U.S.EPA ID Number 8. si Haled Facih Name af�d Site Add � �n �-1ar�oor�,.rl V• S eru�� U.S.EPA ID Number � er+Can krC.I> C 6WO)Q_,-1'-I bo Facility's Phone: 8i Q �_ 1 L.,R Iq gar 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(it any)} 13.Waste Codes No. Type Quantity WL/vol. cc 1 lammab(c 1--�$ut NOS ,3, u/)IGg6,ipG-R7 1 N C' X C0PZ>olrne, ;ACC ne,),�e1 !UP,)CPF' tPBCjg74) 0,23 f�� w 2 l�a►n�- a�cd +fY10. rto�ls, pnla(D;, PisT a. 14.Special Handling Instructions andditivnal Information � .) (n�Q��9 i� X 55 +6m ) 74-H5acd _ 7n �bCf::' 3.)7yg5a7 . XSSam -coo i So_w x j LA a i 15. GENERATOW&OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fulfy and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded.and are in a8 respects in proper condition for transport according to applicable international and national governmental regulations.tf export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a Targe quantity generator)or(b)(if I am a small quantity generator)is true. Gener, a1�OfterorsPdn_t ypedName igna a on ay Year I le- 16.International Shipments ❑Import 10 U.S. ❑Export from U.S. Port of entrylexit: Trans ortet signature fore its only): Date leaving U.S.: au 17.TransporterAcknowledgment of Receipt of Materials Of Transporter 1 Printed/Typed Name gnalure Month Day Year o �/ ea- v�Gtv1 LA i Q Transporter 2 PrintedfTyped Name ig ure onth Day Year O 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑ResiduePF ' C �(b 41jection Manifess Reference Number. TSL} 18b.Alternate Facility(or Generator) Q l _ LL Facilit's Phone: d I�lu! H18c Signature of Aiternate Facility{Or Generator) /tl7e f 7 I a km tj y Year Q �qbt� Z I GD iz N] 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) v 1. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous matedais covered by the manifest except as noted in Item 18a Pr6ntedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)