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Please print nr type.(Form designed for use on elite(12-pitch}typewriter.) Form Approved.OM8 No,2050-00 UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3,Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 5.Generator's Na - G B F Name and Mailing Address " --u -J; .' 1" -22- J Generato-1;-lit;td-dress(if different than mailing address] i., VV 0� I Generaloei;Phones, " N 6.Transporter I Company Name U.S.EPA 10 Number 7.Transporter 2 Company Name U.S.EPA lD Nu;—ber -- Ni",ihrL 8.Designaled f=acility Name and Site Address- U.S.EPA 10 Number Fabli sPhcne,,!,:1-L Ra. 9b.U.S.DOT Description{including Proper Shipping Name,Hazard Class,ID Number, 1D.Containers 11.Total 12 Unit HM and Packing Group(it any)) No. Type Quantity WI'JVGI. 13.Waste Codes 1. LU V ' T 3. 4. 14.Special;Handling Instnictions andAdditional Information IS. GENERATOR'$IDFFEROR'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. marked and labeledfplacarded,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 EPAAcknowledgment 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. ZeneratoesfOfferors PfinlecifTyped Name Signature Month Day Year -J 16.International Shipments El Import to U.S. ❑Export from U.S. Port of antrylexit: 9 FTranspoNer Signature(far exports onlyOats leaving U.S,; ): TransporterAcknowiedgmeni of Receipt of Materials LJ N J Transposer soo I P r Transperier 1.Priliffid/T yped Name Signature Month Day Year CL lransporlef 2 Printed/Typed Name Signature MoAlh Day Year'- 18.Disvepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 78b—Al—ema—le Facility(or Generator) Manifest Reference Number. U.S.EPA ID Number Q LL. Facility's Phone: LLj 18c.Signature of Alemate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) I a - 2. 1 1 — 1 4, 20,Designated Facility Owner or Operator.Certification of receipl of hazardous materials covered by the manifest except as noted in Item lea PrfrilediTyped Name I Signature Month Day Year EPA Form 8700-22(Rev,3-05) Previous editions are obsolete.