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Pjease print-or type.(Form designed for use on elite 2-pitch)y,_,vriter.) 140022+63WO01 9C PI1W 11r 201:. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Numb r 2.Page 1 of .Emergency cy Response Phone 4.Ma>JjfebT�cl�g�mger�5 F L E WASTE MANIFEST f= IA [.0 0 if 1. 3 is 6 3 :� 900 4633i71R t (V, // �`//ff}} 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Suck-ten U.`UT dti<nu H to 144 N EI F'inai�)rinl@ [3Ej4'M rat 5#44 xuiC�4 aA Dirr Generator's Phone: (; 6.Transporter 1 Company Name U.S.EPA ID Number r' +'Irsati"arbor's}.t:vitnntirt�rit al St�t1Ce5 inc M A D 0 :3 9.3 2 2 2 5 U r MAY 07 2014 7.Transporter 2 Company Name U.S.EPA ID Number f; 8.Designated Facility Name and Site Address EWRONMENITI AL U.S.EPA ID Number #Avan Hwbor~s ArajImtte 1.1(: HEALTH DEPARTMENT 11600 H(wth AntuS RoadiJ i t3'3 81 S�i 21 .T Grants+ritM,III f!40..{) FacilitysPhone: t3f34alo ga 9b.U.S.DOT Description(including Proper Shi ing Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Haste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. -W.", 14i 402,WAS'!f.c:Af '11 .P7f CARBIDE,4.3.Ki 1 00011 551. 0001 DQ0 3 o 0 6(10 6 p f , y ; LU Z 2t�a��ccaa a,wager�Y.rnpr rw� i an♦��►[tf�n�f! _r�tt rnn �cr ta>t cr551 WO 0 0 0 .i�) '-N0 1-t*MAN ZARDGU W JNILZ TE.`aoll0.11RQN.( fMPHiTE1 4. 14.Special Handling Instructions and Additional Informat on 1 _LRC11TJ E;RG. 19 0 1.x5 : .f,cckA t .CROO1sav 1xs 15. GENERATOR'S/OFFEROR'S CERTIFICATION: Iereby 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 respe s in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignor nt conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identi ed in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generatoes/Offeror's Printed/Typed Name ignature Month Day Year 116.International Shipmentsf ❑Import to U.S ❑ P Ex o t from U.S. Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: 17.Transporter ter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Z Transporter Printed/Typed Name Signature Month Day Year a 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1" jW40 2. t) 0 a. H143. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are 01 solete. GENERATOR'S INITIAL COPY +Apart Hwbors hils the Alw p►iale E efrrtft, too Affd wtff utgept It*#waStr the gentfator tS ShIllp-w!.