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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS I Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Numbs WASTE MANIFEST ��I"�°�y 9 a 3 n 3 9 3 V 1 G B F 5.Generator's Name and t.'a irg Address WNDI)Mlr N1tUJtL:1 L1 Generator's Site Address(If differert than mailing address) •r,EN <, I S N. yU I I kR %1 s 307 "M k MAN ST ,1("Ck I k)h.GA W42015 %'TOMON CA Wb,7itli Generators Phone: "V 6.Transporter 1 Company Name U.S EPA ID Number 7,Transporter 2 Company Name U.S.EPA ID Number 8.Des!gnated Facility Name and Site Address ti�4il�IrMAiJ 4;4�,Lu, U.S.EPA ID Number 11006 11111111111111 ROCK itU -r,LIr48C W 1 IiANt;'F}D GLrit[�1rA C:h Y�JI.' tr iIr i tiii0() Fadlit s Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contains s 11.Total 12.Unit HM and Packing Group(if any No. Type Quantity WINol. 13.Waste Codes 1. O W Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information L - All r i If* WillIN;EMY L-01111111,111 AC i SKI t 't 1 1 15. GENERATOR'SIOFFEROR'S 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 labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAckrowledgment of Consent. I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If I am a small quantity generator)is true Genetators/Offeroes Printsiffyped Name Signature Month Day Year J 16.linternationaT Shipments 111 Port to U.S. ❑Export from U S Port of entry/oxit: Transporter signature(for expoets only): - - Date leaving U.S.: LM 17.Transporter Acknowledgment of Receipt of Materials OTransporter i P intedliyped Name Signature —1 Month Da Yeer CO2 r Q Trarlsporte 2 min ypeC Name Signature Month Day H- 18.Dlscrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA 10 Number J U Facillty's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z w19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2• 3. 4. 20.Designated Faciilty Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item Be PdntedfTyped Name Signature Month Day Year EPA Form 8700-22(Rev,3-05) Previous editions are obsolete, TRANSPOR I 'S COPY