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'lease part or type.;Form designed for trse on elite(12-pitch)typevrriter) Form Approved.OMB No 2050-0039 <br /> UNIFORM HAZARDOUS Generator lD Number 2 Page t of 3 Ememencv.Resoonse Phone 4.Manifest TrackNumber <br /> WASTE MANIFEST e4 LOOO I fli ( 39 1 19,66-5.33-9 22 Z 002107648 F L E <br /> 5 Generator's Name and Mailing Address L ` Generalci s�Site Address(d different than mailing addressi/ <br /> S�oL lc{o [ Q S 2 f 140,2 A/ <br /> Generators P-one :209-4 32 -6601(" <br /> 60 <br /> 6 r ansporer 1 Uompany Name US EPA <br /> ID NNumbeer, <br /> Wxv•C� G��.�^ C'p' � Q/fs o�T ti'r r�(/[/V(J 7� ��U <br /> Transporer 2 Company Name US EPA IC Number <br /> 8 Designated Facarty Name and Site Address US EPA ID Number <br /> I F�CJ Gc7- Adv-, d-•-e- <br /> g J .DOT Descriptiw);inducing Proper Shippirq Name,Hazard C+ass.C Numbe-. is Containers 1++ Total 12 Unit <br /> yip a-d Packing Group(:f anyi) Ng T.yce Quantity Wt:"dol. 13 Waste Caries <br /> �d QGQA NRZ.40-ov v�r4S�E, �� cz✓1D t — -- <br /> 0 <br /> Z•s r--- <br /> COIL14.1 <br /> r <br /> Z2 tj 01,j ¢'G2i1 f}A zAQL1DvS WR 57Ez L r 61 t/f 15 zZf <br /> a,AJ 0,%/ LQA 7Ae0o'Le S u+ASrE L r GZ�t ' <br /> ---f-------- <br /> �oAj 26&sq IiazA2 ,;s she, L , QUI o <br /> a <br /> 1Y )1 D iz3 <br /> - -T- --- <br /> Special-larding Ins!ruclions and Additional Informalior. <br /> 3�0g1a"(;?b 00),007, <br /> e,7g10017q d---V'- 0ore Ixss) 4) 091001-2`7 <br /> ?O_j e Z-4 y,j L/ : C✓-0-907-S7- <br /> 15 <br /> pUZS15 GENERATOR'SIOFFEROR'S CERTIFICATION: 'hereby declare that the contents of this cons.onment are fully and accurate,y desrsibed above by the proper shipping name.and are classified.packaged. <br /> marKed and iabecedrp+aca:deC and are m all respects in proper condition for transport according to appncable international and national governmental regulations.It export shipment and I am the Pnma v <br /> Exporter.I certify lha!the cOrterts of!his consignmert conform!o the terms of the attached EPA.Acknomedgment of Conser!. <br /> i certify that the waste minimization statement identified in 40 CFR 26227(a)(if;am a large quantity generator]or(b)(if I am a small quantity generator;�5 true <br /> Generator 'Offerors Prince ped Name ..�ana a on ay Year <br /> j 16 :,ternato,a,Shipments <br /> Import to U 5 Ex,,l from L.S Pg <br /> z <br /> Transporter s. rall(tor exoors onlvl Data eawing U.S.. <br /> W 17 Transporliter Acknowledgment of Receipt of hlatena!s <br /> Trans )/rinted"yped Nam/ � w^ature Month ay Year <br /> O <br /> z Tanspo5er 2 PnntedrTyped Name ion cur„ Month Day Year <br /> Q <br /> 18.Discrepancy <br /> 18a Disc,reparcy indication Space <br /> —i Quantity n?ype _Resrd:e -_J°ar,a'Relecten `,Full Relecbo^ <br /> tannest Reference Number <br /> F- 'Bb..A!ternate°r..li>y afor Ggneratort <br /> U S EPA 17 Number <br /> U <br /> tiQ <br /> FnGi;y's Phone. <br /> 18c.Signature of A'ternate Pactiry(or Generator! Month Day Yea, <br /> w <br /> Q <br /> Z <br /> to <br /> iS -lazardous Waste Reoo.^,Management Method Ceoes;I e.codes for hazardocs waste treatment.disposal,and recyoirg systems` <br /> w 2 3 4 <br /> 0 <br /> 2C Cesigrated Facility Owner or Operator Cerrtfrcation of,eceipt o'hazardous materials covered by the manifest except as noted n.Item 18a <br /> Printed-iyDedName 5gnatae Mrnth Day Yea, <br /> .PA Form 8700-22(Rev 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />