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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 1 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 0 A D 0 8 2 C 2 6 4 2 9. (800)424-Ci300 - 7 kS, i'9 3 JJ K 5.Gen atq s y e nd.Mgili Md[ess Generators Site Address ff different than mailing address) ? I!f !I It1 f vrtr L l'u'7i{.I`lkEGA lA.< 9f-336 ..1ii IVlS�7 i"f fJI 'PE� C3:s,2,:59-a.:i5 9 MAN I Evil Sed, 9581;� Generators Phone: 6.Tran her 1 Company Name U.S.EPA ID Number eft; ;l_Lf::tlr �rJ ±I C}111 fEI Il;t_W-ERViC,€_S CAC 0€121: 2 l Y Q 3:5 7.TranspoJr�t"er 2 Company Name ff�pp y U.S.TEPA ID Number 010 R I.C�i'ill CIE Rw�.YSJ�'L..R.'Y SYS]'E--m MC, i Ya F'+.L.,'0'..3 1. r -5 Fi 2.2._- 8.Designate�d nFacifi Nam�e.and Site Address U.S.EPA 0 Number YUMell it 85365 Facility's Phone: (.9 8).44,E-9$28 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.1vol. 1.NM4-P,CRA -A:.f,sRDOUS WAS i E, SOL'D 01 SC1Li L, 'APER rl!F ERS1 D's'sf's + t P 1 z Z. L c� r 3. 4. g i 14.Special Handling Instructions and Additionai Information I l~MERGEK`( C O fAC2 : C HErATRE-0 !-6-W-424-93r:3WOES TERMINAL GVEIiEs CS 'l pc? SIL E v"wEi.I. 1.1!(3?.! OIC':Sfif..0, #'A'r"ER r=IC ERS "WPROPRIATE PERSMAL PROJECTIVE EQ:AWi E=Ni' 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 classed,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 EPAAcknowiedgment ofConsent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(ff I am a small quantity generator)is true. Generators/Offerors PrintedlTyped Name ignature .-- � Month Day Year,,-: hAl E .] 16.International'Shipments r ❑Import to U.S. ❑Export from U.S. Pcrtof entrytexit: / Transporter signature(for exports only): Date leaving U.S.: Of 17.Transporter Acknowledgment of Receipt of Materials Transporterfi rintedfryed pName i Signature Month Day Year tYr i ,f. r cj f'c'l _ g CL t V�[ r` I'. ir)„ '• :1✓:- ' �,r N Its-'� E , n. 5- lV, U) Transporter 2 Printedrryped Nam,f- 9 Sign a(ure r;✓'y Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space _ Quantity_ Type ❑Resltlue ❑Parial Rej,,tion El Full ReJechan Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number zi U " L Facility's Phone' W 18c.Signature of Atemate Facility(or Generator) Month Day Year a z rn19.Hazardous Waste Report Management Method Codes(La.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. f + 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest exi*as noted in Item 18a t. Prinledlryp d Narpe Signature r f Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ' t ``DESIGNATED FACILITYTO GENERATOR