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'n 17 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator M Number12.Page 1 of 3.Enter en7 Response Phope 4.Manifest Tracking Number 007314 SKS 04f fe)7Z WASTE MANIFEST 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ;nr Generators Phone: 6.Tri p�pqqprj,.0 U.S.EPA ID Number 7.Transporter J 2 Company Name U.S.EPA ID Number 0 V ,Ffl 1,",WHWFK i',13"A)l` 1,)-11.` A 8.Designated Facility Name and Site Address U.S.EPA ID Number oi,M,-44 J I,fr30- Faciliys Phone; 1 1 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes Him and Packing Group(if any)) No, Type Quantity Wt.Nol. 1 am, 'n tj f L 3. 4. 14.Special Handling Instrmilons and Additional Information ]� ;3y 1` A 0 q 1 c,�r a S V�e,r,c,U I:-R,l i"Ac v F, em .4 G fi 1 f r 2'r.a.J i iq tar 0V, J+1 Y. i; r: "t d h,ai J;E1 t d r I'i 4"J J.jvB 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, marked and labelediplacarded,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 EPA Acknowledgment of Consent, I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorslOfferors Printed/Typed Name Signature Month Day Year 16.International Shipments Ll Import to U.S. ❑Export from U.S. Part of entry/exit: Z Transporter signature(for exports only): Date leaving U.S,: ix 17.Transporter Acknowledgment of Recelpt of Materials Transporter 1 PrIntedlTyped Nam� Signature., Month Day year 0 CL Z Transporter 2 PrintedlTyped Name Sigriaittifo Month Day Year 10.Discrepancy 1 Be.Discrepancy Indication Spare Ll Quantity LIType 0 Residue 1:1 Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: LLJi 18c.Signature of Alternate Facility(or Generator) Month Day Year ,It- Z 0 19.Hazardous Waste Report Management Method Codes(l.e,,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17).Previous editions are obsolete. ENE TOWS INITIAL COPY