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Please print or type.(Form designed for use on lite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID umber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST s~ G B F 5.Generator's Name and Mailing Address COMORklmss(if different than mailing address `'►AI_L�.:dl WAY IIRE' ('(ii ,lick i t�•1�Vv 11 rti,:y rl1f.ET Generator's Phone: 6.Transporter 1 Com y N nie U.S.EPA ID Number s.� i 4J itA+�APIY� 2i"14 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S EPA ID Number U4-M PAN-W)(;(_4L:J()YA, i ft51)1Mi 1 L RX. Rri I +lb.1140 CCORLY VA,(-A W-,1,a: Facility's Phone: fi.,+� 1.f -t ga 91b.U.S.DOT Description(including Prope Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1' 14014•14C RA HA2.A)?L ,A.1`„+�VA!;1 k ltJt� 1 UM M r' <�°3 Y)2.,tt':�0RK-N1 PA(k,is >It. Z 2. LUv 3. D 4. I1 14.Special Handling Instructions and Additional Information PfillSLE W244M— AF144C41MA I U)PROTEt;TlwF it I.,)I Rwi W., E EW."0111 15. GENERATOR'S/OFFEROR'S CERTIFICATI 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 spects 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 cons nment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement✓dentified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 1 am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature V..--- Month Day Year J 16.Inlematidnal ShIrrments I— ❑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 Transporter 1 Printed/Typed Name Signature Month Day Year CL1 H r' ZQ[774der 2 Pr n e(fp d Narner I I- Sfgn5turi''� Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z H19.Hazardous Waste Report Management Method C es(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ILLI 1 3 Notice:New federal form. State of California requires generator to photocopy 20.Designated Facility Owner or Operator:Certificatic n of receipt of hazardous materials covered by the manifest except as noted in Item 18 and mail to DTSC within 30 days: Printed/Typed Name Signature P.O. Box 400,Sacramento,CA 95812-0400 EPA Form 8700-22(Rev.3-05) Previous editlons a obsolete. GENERATOR'S INITIAL COPY