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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 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST1,1. �, "% tY � � s _ :•<� 0088,1L5358 �' JJK 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) , Generators Phone: { 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number :IF-NEN jI �TRY, l %( uw Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes 1 No. Type Quantity Wt.Nol. f.;F2.2 11, rI� E- "ic't�,�'l,tE. �dW��:_�F- ''3(.f1.��C:�L 7 ` ?�' ".••-------�--..�...�___._._d. Z 2. W L7 13* 4. 14.Specialfiandling Instructions and Additional Information _- t;i c1 #� ,,, . ' -gam.d;? . P I t fC'I 1 1 " �'f�",$;.�1-Itu A k . ,,p . I a,: � %� 15. GENERATOR'SIOFFEROR'S CERTIFICATION:TWWeclare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects 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 consignment conform to the terms of the attached EPA Acknowledgment 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. Generators/Offerors Printed(Typed Name Signature Month Day Year -A 16.International Shipments Z 1:1Import 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 Transpprtet 1 Printed[Typed Name Signature Moth Day Year O a N ZQ Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection I 18b.Alternate Facility(or Generator) Manifest Reference Number: J U.S.EPA ID Number E3 ty Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O1 2. g, 4 a 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 YQ EPA Form 8700.22(Rev.3-05) Previous-fditions,am obsolete. GENERATOR'S INITIAL: