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Please print or type. Fonn Approved. OMB No. 2050-0039 <br /> _-- <br /> UNIFORM HAZARDOUS 1. Gen 1 IDN bar 2 Page 7 of 3 EmergencyR,sp e Phone 4 Manifest P k n Number <br /> WASTE MANIFEST ,A ! E, "rF't'1ds} r 'n ! � ...0 ., < .. 0 JJ <br /> - 5 Generator's Name and Mailing Address G nesters Site Address (if different than mailing address) <br /> S i CKICa! s:tF: :L L'3v1. tr' tri:;• Nr`°4"rf " . i,JK� . <br /> STFOCKTfNd. 1rA. %21 `F` U:3A <br /> Generator's Phon : 1 <br /> 6. Transporter I Company Name U.S. EPA ID Number <br /> (Uyvt1Dr31wl!yV1h'iY3AiA9kNTAL :Id:,E <br /> 7. Transporter Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Silo Address 1 moi- IF t I ,i Icy t pt- 1-1 ,n. -,7 U.S. EPA ID Number <br /> IF <br /> -, <br /> +? FA F4C 1-IC _i Pal vLf. <br /> Facility's Phone: <br /> 9a 911 U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 , Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity WIN01. <br /> i, U7,1'125.1, YTASiF: V7174 s , ;? , 't;Ul <br /> K <br /> Z 2. <br /> w <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions and Additional information <br /> 38-II)PROFILL I L " <br /> E.R. Cf7NTRA.CTOR' RAMOS EN41RONVED1TAL <br /> HANDLERS SHOULD BETRAINEDAND USE APPROVED PPE � <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: Ihereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable International and national governmental regulations. It export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the tenns of the attached EPAAcknowledgmenl of Consent. <br /> I cergfy that the waste minimization statement identified in 40 CFR 262.27(a) (it I am a large quantity generator) or (b) (ifI am a small quanfity generator) is he. <br /> GneratoeslOffemes PnntedRyped Name Signatures /' MonN Day Year <br /> 16. International Shipments <br /> E] Import to U.S. El Export from ll���. f; Port of entrylexit: <br /> ? Transporter signature (for exports only): l ' Date leaving U.S.: <br /> W 17. TransporterAcknawledgment of Receipt of Materials <br /> bill <br /> Transporter 1 Pdntedrryped Name 7 Signature - Month Day Year <br /> a <br /> z Transporter 2PrinlediTyped Name - - Signature - Month `Days Year <br /> r <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity El Type ❑ Partial Rejection lection ❑ Full Rejection <br /> Manifest Reference Number: <br /> r}- 181h. Alternate Facility (or Generator) - LLS. EPA ID Number <br /> U <br /> uQ- Facility's Phone: <br /> w 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> z <br /> N19. Hazardous Waste Report Management Method Codes (i,a., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 . 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item lea , <br /> Printedrryped Name I I Signature - Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />