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.. r <br /> I ��Uiv4 C='fv .. <br /> � ARir;7U5 <br /> r,>. I __!�"��fi�— <br /> I IV) �!A�� ��r, r4;r .?" R ' "' isg � t <br /> � ��0�" .1 ��:�c�.f ,.�' �>�? �=� -`�•l�=t�-iE <br /> 7�70 <br /> � .} �i1 � t- 'r y}1 VY% i v t�tG% `'f ,r _ J { _ r '�•7'tl. `l 1 <br /> I <br /> 1`36a<r's Pncne: <br /> 9h U 5.` '"Ce<.cri,rtoe t r,I.ding=roper Snipp ng Name Hazard%lass iD Number 10.Containers ; iota; U is <br /> 9a. 3.'Naste codes <br /> Hod and I=__" - No Tree Quantity W+..;Vo <br /> Cr 5f <br /> DIN 3o <br /> W � L ace 5 C I <br /> W <br /> 2 <br /> I <br /> I <br /> 4. <br /> 14.Special Handling instructions and Additional InliDrmatian <br /> 1 t GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately descnbec above by the proper shipping nan-,e,arc are classified packaged, <br /> marxeC and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governments!regulations.If export shipment and!am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> !certify that the waste minimization statement identified in 40 CFR 262.27(a)tit I air a large quantity,generator)or(b)(if f am a small quantity generator)is true <br /> Generators[Offerors Pdnted.rryped Name Signature Month Day Year <br /> J 16 International Shipments rr <br /> u import to U.S. Export from U.S. Port of entrylexiC —_— <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> tY 17.Transporter Acknowledgment of Receipt of Materials <br /> lW Trans r 1 Prime 'Typed Na Montt, Day Year <br /> 0 f <br /> ZCA Lid <br /> i( ar le5 R Tran ,er 2 rinted?yocid Na .e Sign&e_ I Month Day ! Year <br /> c <br /> le.Discrepancy <br /> 152.Discrepancy Indicatt..3n S ace f' r ❑Partial Refection ^�Full Rejection <br /> p Quantic. !'yes. Rescue _. ! <br /> Manifest Reference Number: <br /> >- 181b.Aitemare Facility ror Generatoo U.S EPA!D Number <br /> J <br /> U <br /> ta+ Faci:it7 s Phone: <br /> W 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> C <br /> Z <br /> 19.Haza,dous VJasie Repor.Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,aid rerydn systems) <br /> Uj i 2. 3. 4. <br /> 20.Designated Facitity Owner or Operator:Certification of receipt of hazardous materials covered by the manifesi except as rioted in Item 18a <br /> Pr'nted,7vrx,d Na^>e Signature, Month Day Year <br /> EPA.Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•IU ANiFES1 SYSTEM <br />