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7-S C. �,d,/ j.�` 1r�0 Sc.c r:,4 [/S S�JZ L✓i ,�i 3 o vlays <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> 1.Generator ID Number Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 2.Page 1 ofa- -Mag <br /> 4.Manifest Tracking Number <br /> WASTE MANIFEST �¢,��od S 7a pF' <br /> 1_S'00 010828262 �I�!K <br /> 5.Generators Name and Maifing(A Address enerators ite Address(if different Utan mailing address) <br /> KriNz a S� <br /> a k&0 _5 C=L �z7iZq,t�o s%. <br /> �rZeClC�o,� , C.¢ 9S?oC- <br /> Generators Phone: ZO 92 2-S'7 41C <br /> o.Transporter 1 Company Name U.S.EPA ID Number <br /> remit �,rlri � �. , / ti✓, '- '- Gads 75//�Z <br /> F7.Transporter 2 Company Name <br /> . U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressU.S.EPA ID Numbe <br /> C'VE72G.2.�45-A/Ole- t rn�C• <br /> &yV8'0 Stir iT.�/ ,ffii6_ <br /> ter✓ y'YSG 0 <br /> Facl' sPhone: 570 793-- yy100 <br /> ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit T 6 <br /> HM and Packing Group(if any)) No. Type Quantity WtNei 13.Waste Codes <br /> � 1 U iU/Ory 3 � G./cS�� �l��s-•c 6 <br /> 0 �r o,S, 3 . `✓G7l � ssr �,� <br /> 003 <br /> W z. UW307/, w�S /Nere4101.r s, '1 o-+, 5S/ 1�cac <br /> 3, �� <br /> 3. uAl zi '/D, 7-Orxi e Gs pW`p/.5, �Hs r- N <br /> G- <br /> 4. .4 <br /> T- <br /> oo,, �= 003 G <br /> 14.Special Handling Instructions and Additional Information <br /> [9}b1.� <br /> /1--- Z -aO7, <br /> 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, <br /> marked and labeled/placarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. = <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(If I am a small quantity generator)is true. <br /> 7neratorsl(0lfemrs PrintedfTyped Signature Mo% Day Year <br /> J 16.International Shipments <br /> P ❑Import to U.S. ❑Export from U.S. ort of /exit <br /> Transporter signature(for exports only): Date leming U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> o~C Transporter 1 "ntedflyped Name S" * Month Day Year <br /> O <br /> 0. <br /> cc <br /> za Transporter 2 PrintedlTyped Name Signatu Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facilitys Phone: <br /> LU 18c.Signature ofAltemate Facility(or Generator) <br /> Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1' 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />