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Please,print or type.(Form designed for use on elite(12-p4ch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator!D Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST I eA L 000 1 ag 13q 966 `333- 1222 1 002260806 FLE 5 Generators Name and Malmo AddressL Generator's Site Address(if different than mad ng address) 1-t• 1.waY QS �`vrG 1� Cp++.,��.c/ �j.-•Aa �y sfoee�Go. , �a 2es t2Sz �. sly., sle�s sfl Generator's Phone' 2O -1�7 3� - o 06 S�o e�� • , t^'c 9 s z 0 2 6.Transporter 1 Company Name U.S.EPA ID Number 7 Transporter 2 Company Name U.S EPA ID Number 8 Designated Facility Nara and Site Address US EPA 10 Number r-/4e- eZye_b., r S•tL 1 eo 4j. OA4 e_ A- -, ibol4-o , Ca g23t6 � r �/ /I/ FaryMtys Phone: ew- " - 7 'rY�7 0'7 y V`7 `I 0 / 9a 9b U S DOT Description(including Proper Shipping Name Hazard Class.ID Number. 10 Contair vers 11.Tota! 12 Unit HM and Packing Group(if any)i 13.Waste Codes No. Type Quanliry Wt.Noi. 0 1 �O� Q«r9 9ATAR06�'S tvAST Lla��tr� 77-1 i w 2 t ! O r 3 i i 4 14,Special Handling Instructions andAdditKxna!information ��(ZrcSS� G,rF - Sol , Pia 2 06100 t27) Peoj �c r /i C' - er-2 : C✓OO DS/ 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged, marked and Iabeledrplacarded,and are in all respects in proper condition for vansport according to appkcabte mtema;onai and naborai governmental regulations.If export shipment and I am the Primary Exporter.I certify that the contents of this consignment conform to the terns of the attached EPAACKnowledgmen!of Consernt. I certify that the waste mininczation steterrent identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a sinal:quantity generator)is true. GeneratoesdOfferors Pnntedqyped Nameigna on ay Year i Ib P 16 Int bona)Shipments Import to U S ❑Export from U S Port of entry!exn ---- ..-__--- -- Z Tansporter signature(for exports Date lea U S. U= 17.TranspalerAckmowfedgment of R of Materials I.- Transpo 1 n yped Name gnat Modth Day Year O Z Transporter Printedrryped Name Xgnatth Day Year Q 18.Discrepancy (F��}} 18a.Discrepancy Indication Space F-1Quantity ❑Type U Res due —I Partial Rejection ❑Full Rejection Manrtest Reference Number 18b.Alternate Facility(or Generator) U.S EPA ID Number U Q LL Facili, s Phone- W I Be.Signature of Alternate Facility(or Generator) Month Day Year 4 Z O 19 Hazardous Waste Report Management Method Codes(i e.codes for hazardous waste treairnent disposal.and recycling systems) N Wt O 2 3 20 Desgnated Fac"Owner or Operatce Cer ficaton of receipt of hazardous matenas covered by ft manifest except as noted n Item 1 sa Printed Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)