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00 <br /> ,0 <br /> 1ea e:pant orp <br /> tye,(Form tfeaignJfor use on elite(12=pitch)typewriter) Form Approved.OMB Na.2050-0036 <br /> 1.GenLL erator ID Number 2.Page 1 of .3.Emergency Response Phone 4,Manifest Tracking Number [[ <br /> 'UNIFORM HAZARDOUS D. 3 �� ��2� 0 0 . i <br /> WASTE,MANIFEST <br /> 5.Geq rotors ad m Add y"a'5 + Gee tors Site Add s if different.than molting address) <br /> rye €g <br /> 1 1775 L6W09 A <br /> Gaucratar`s Phone: <br /> 6,Transpoiter1 Com pan ame U.S.EPAID Numbar <br /> (Sty menta)( '"ERA��A E—Cust 119 876 G � �) � 1��7�� <br /> 7.Tran rter 2 Cam ny Name U.S.EPA ID Number <br /> ortetf.1 R� � rtaa� 9322250 <br /> 8.besig`led Pac ii a e a d 5'te ddr ss �� U.S.EPA ID Number <br /> a _ <br /> Facillty�s Pltdrie: ":_ ,y. j <br /> dam.: <br /> 9a. .Ob..U.S.DOT D'escripllod(irlclud!ng 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 Quanllly M.Nol. <br /> 1.l FSS 's� 01M >�91ruldoi��:�. .�8sopropo. �� .51 0101 <br /> ry <br /> N 2,�� mm 3 caste,�iquK�i. .( bW 6PV0 , ,011 <br /> 14,SpWW Handling Instrucllans and Additional Informatio <br /> 041 fes-WAY 6074 <br /> 1) � DOT�R 126 WEA 1 LOCR®1 a9 Kt2 } `1 DOT R 1 1 '�4 F � R 1 H <br /> 2)' @-W eel SIM-DOT ER 1 . -2.I LCC RAI���'.��. . 4) t 15 00T'ERG:WE-41 LCC. <br /> .� R2 <br /> 15, GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that the contents"af this consignment are fully and accurately described above by the'proper:shipp#ng name,and are classified,packaged;..marked an <br /> labeledlplacard'ed,and are In all€espects!n'proper condition for transport according to applicable intdmaaonal and nallorrai govemrdental regulations.If export shipment and I am the Primary. ' <br /> Exporter I'ceglfy that the contents o€this consignment conform to the terms of the attached EPAAcknowledgment of Consent. . <br /> I cetllfy lhafihe waste-minimization statement identified in 40 CFR262.27(a)(if I am a largd quantity generator)or(b)(if I am a small quantity ge tot)is true: ; <br /> GeneratorslCfferorsFdnedffyped.Aloins' Signature Mo lh D"a Year <br /> 'a 16.Inlematianal Shipments <br /> .. � Impnrtioll,S, - ❑Export from U.S,: P ss aniryls . <br /> Transporter sign ature(for exports only}:- Da a leawng . <br /> x , g <br /> �_ 17>lrapspoilarAckno�vtedgrneh%gi,F3e4ipTuf.t�ater%als. <br /> Trans e�1 PttnledfT ed Naure= .^ n SignalbreV. <br /> , Month Year<.`. <br /> ont Da Year'' <br /> M h 9 <br /> .� Tran'sporlt:i-2•"hl"d1TYped.�.rame ' - .:�' 9 _ - ;' . <br /> - :4fs;plsciepan4 }-• •7' �,F::' <br /> esclidn.' <br /> Vy <br /> 7777 <br /> Fi€!R <br /> t8a;piscrq`pancyr'tndlcatioii Space•; e O Residua ,Ratlial Rajecifoh l ( - <br /> . :�.Quaritily? °I�TYP - -. . .. <br /> Manifest Reference Number, ' <br /> 18b.Alternate Facil€ty(or Generator) U.S.EPA ID Number <br /> L) <br /> Fac#lilj�s Phooa: <br /> Mon11i Day Year <br /> �. 1pc,Signature of Alternate Facility(or Generator) <br /> 19;HazardoustNasteYReporEMapagementMethodCodasQ. ;codes forhazardouswastetreatment,.dlsposal,andrecyclingaysfems� <br /> z. 4�1� � 34 14. i`{: j� <br /> 20.Designated Facility Okvner or Operator.C6djfcalion of receipt of hazarduus.materials covered by the manifest except as noted in Ilam 18a 4 V <br /> PdnlediTyped Name 44 11 Signature - i � T; =Day <br /> EPA Form 8700.22(Rev.3-05).Previous editions are obsolete. t f' DIEW AT TO <br /> `F <br />