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W.� Form Approved:OMB No.2050-0039 DUS 1•Generator ID Number 2.Paget of 3.limergency Response Phone 4.Manifest Trackin Number ESr 014-00021 SWIM 00 ®AT +m(��e;and Mailing Address fljTl4;, Al l"r ¢� y Generators Site Address(if different than mailing address) Fit r1€.1j I:fj :il TUM Rw.�" tHIIA '.�ei:+�tt - .ors Phone: ` rlsporter 1 Company Name U.S.EPA ID Number it.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA iD Number Swo Jvos CAVE g60 Facil€ty's Phone: ga 9b.U.S.DOT Descriplion(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Tetal 12.Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantify Wt:Nol. UtM1760,14 -sfevGatgciciteU€;:uidc, .ey. t G, , 1 U€ add), 0002 D406 50111 10 r eu ?-RCIR A Kam ar; Y � e��e'15��t�)<�it1�.��rf�se��)��Ft�d+.g€tl�,t rr)t•�mr r� - ( i� � VIM 3. 4. 14.Special Handling Instructions and AddItional Information pie 15. GENERATOWSfOFFEROR'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 labeledlplacarded,and are in all respects in proper condition for transpott according to applicable international and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of Ihls consignment conform to the terms of the attached EPAAcknowledgrgent of Consent. I certify that themaste minimization statement identified in 40 CFR 262.27(a)(H 1 am a large quantity generator)or(b)(ill am a small quantity generator)is true d GaneratoeslOfferoep Printed/Typed Name ;P%' Sig'ha�rye, Month bay Year V, t.,, 16.International Shipments i ' { 4 F— ❑Import to U.S. ❑Export from U.S. Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: W 17,TranspoderAcknowledgment of Receipt of MaterialsUj .r Transporter 1 Printed/Typed Name a Signature r Month Day Year O ``p '." a z Transporter 2 Prinledifyped Name Signature month Day Year H 18.Discrepancy. 18a.Discrepancy indication Space Quantity ❑Type ❑Residue ❑Partial Rejactlon ❑Full Refection . Manifest Refefence Number: F 186.Alternate Facility(or Generator) U.S.EPA ID Number U ra Facility's Phone: w 18c.Signature al'Alternate Facility(or Generator) Month Day Year Q z r�. 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2, 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 1 Be Pdntedfryped Name Signature Month Day Year EPA Form 8700-22(Rev.112-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY