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Please print or type.(f=orm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 4 of 3.E ergoncy Response Phone 4.Manifest Tracking Number WASTE MANIFEST 00 � , s(o. y9. 000238771 JJK 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) x"A h -,-t'Z 5 r 1 C�7-- ito-}(n .APCsIGI��C�A tO� -�u• 't>Ac9.11INVAe.4T,3 �A. ifa�1 c.�T f' c.A , ctlS3;t�t> Generators Phone: 1 Z-4 1 lPi\ T if: 6.Transporter 1 Company Name U.S.EPA ID Number micG 1 C �- Irl C P,R coo 0 c _ 7.Transporter 2 Company Name U.S.EPA fD Number B.Designated Facility Name and Site Address U.S.EPA ID Number �y C-R453y � 0-4 f a t r KCo 110"3 a `vel \-jWC-�k C-A k) �-nhLlti C3eAc-W t_ A. O '0i3 Facility's Phone: �- 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes �} No. Type Quantity W1.1vol. 1' ��QN 1LL� � �� Q�d1Jj wG�ST `�Cul1� z 2. Uj 3. 4, 14.Speclat Handling Instructions and Additional Information u5t PF-,OP" �tLoFtL4F s 142-( . 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the contents of this oonsignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledfplacarded,and are In all respects in proper oon0on for transport according to applicable intematlonat and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform 10 the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identifed in 40 CFR 262.27{a)(If I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneraloeslOfferor's Printed/Typed Name Signature Month Day Year .a 16.International Shipments 11 ❑Import to U.S. ❑Export from U.S. Port of entryfaxit: Transporter signature(for experts only): Date leaving U.S.: rY 17.Transporter Acknowledgment of Receipt of Materiels oTransporter 1 Printed/Typed Name Signature Month Day Year Q Transporter 2 Printed/Typed Name Signature Month Day Year F- 1B.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Re'eciion f ❑Fu11 Rejection Manifest Reference Number: 18b.Alternale Facility(or Generator) U.S.EPA ID Number J V u. Facility's Phone: LO 18c,Signature of Alternate Facility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PdntedfTyped Name Signature Month Day Year i EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)