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Please print or type.(Form designed for use o eli (12 tch) pewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.GQneratorIf Nu bar 2. age 1 of 3. m e cy es nse Phone 4.Manifest Tracking Number WASTE MANIFEST �.�? � �� _.. 6„�'w n -9300 Q 03336269 JJ K il 5.Generator's Name and Mailing Addresq s Generators Site Address(if different than mailing address) Generator's r hone: / e ' 6.TransportFt�r (��rrlY�rt}ilttlP t>R� rVff:QS U.S EP ID Number CA�g 4r 3262 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address s Inc. U.S.EPA ID Number 688 Sl7noth AVS, Ne ark,DA 94660 CAD980887418 Facility's Phone: 610- 95-4400 ga, 9b.U.S.DOT Description(including Proper S ipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if an)) No. Type Quantity Wt./Vol. / W LU 3. 4. 14.Special Handling Instructions and Additional Inform tion f r_ 15. GENERATOR'SIOFFEROR'S CERTIFICAtION: 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 respi cts in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignr ient conform to the terns of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement ider tified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I aM a small quantity generator)is true. Generator's/Offeroes Printed/Typed Nam-, na Mond Da! Year 1 iJ ( % 16.International Shipments P__ ❑Import t U. ElExport from U.S. Port of entrylexit: ti Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials ; t— Transporter 1 Priyped Name /� / Signature , ;! r" ; ! Month Day, dear d moi' QTransporter 2 Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuantityT jection ❑ ype El Partial Re Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V u- Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous I Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) /""1' 101. / t 2 �f j L/ 3. 4. /// FF7 20.Designated Facility Owner or Operator:Certification ot receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name ri- -- Signature Month Day Year fie:�f.. < a� EPA Form 8700-22(Rev.3-05) Previous editions are o solete. ��' DESIGNATED FACILITY TO GENERATOR i