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Please print or type. (Form designed for use on elite (12-pitcnI typewriter.) Fnrrn AnnrnvPri nmR Nn vnsn-nnio ENA Form 8/UU-2Z (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number f : r WASTE MANIFEST _ JJK 5. Generator's Name and Mailing Aacress ` Generator's Site Address (if different than mailing address) K fdAll r.� , .64.E :flan c-Zf j el ;?1 Generators Phone: 6. Transporter 1 Corrrfany Name U.S. EPA ID Number - ova;, e ':m , p^* + r•t..W<<t;j �x.;yg,' 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number Facility's Phone: 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. u.l i' Z 2.LLI �) Ue' ii 1AA ?A C r, ,3� zr �`��'1 PA '�7' ,'� 3. A '1 - f 114 l rt tl0eV r. A S i r'd� yds Ile I - } 4. 14. Special Handling Instructions and Additional Information 44 ''u+.+.w.-.....(_,...';........... t'"'#'e��IR"� w,-.,.,.,.. ..,..,�.._, ....7 .'......'_.. ... ,...-.. .«., invowe 4 f/ rj tel' ,' 1OF ' t r 9'.-4115 MarHING f 15. GENERATO 'Std ER R' "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 international and national govemmental 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) ('d I am a large quantity generator) or (b) (if I am a small quantity generator) is true. [5e-nerators/Offeror's Printed/Typed Name Signature Month Day Year F- 16. International Shipments ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials TranspTransp rter 1 PrintldlT ped Name Signature Month Day Year 0- Z Transporter 2 PriftfdrWNarne Signatur - s Wokh 'Day ear F 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b. 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 N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) � 1. 1 2. 3. 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 ENA Form 8/UU-2Z (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY