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Please print or typo. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS i.Generator ID Number 2.Page 1 o€ 3.Emergency Response Phone 4,ManlfeaE Trackln ,Number / ©C <br /> WASTE MANIFEST 0AL,f�€lQif; [k ! 0185"�(98�W580 1006-4 w" 0 G D[� <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mal address) <br /> ArLANTIC AVIAi' N <br /> X652)Plt4f; `REQM'IM iul38'1'Li MOO �$°��a�;�.L11401i V <br /> Generator's Pho ��LANO, X 75024 <br /> RQ' ,mss^ •sn <br /> 6.Transporter 1 ehr amp ame"" U.S.EPA ID Number <br /> A1tf11m6�1CX1d VpalJ,.R 'lf1}A. '�;011..PIC. t,Ar?,'QCW121 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 31'0�ICYO1.,i!,SPIEC AAL fY WAS P,:�; L..0 ir.M,UNIC 31tjN:08011109'24 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> �`i'5T CMjt~1Pt'y'EN`,7IRONVIIE.€' FAL0fll'±` <br /> t"L"u*AKY,tAl 80.408 <br /> Facility's Phoney-5,N 5-7,Tt .l <br /> ga. 9b.U.S.DOT Doserlpgon(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)} i3.Waste Codes <br /> No. Type Quantity Wf.Nol. <br /> 1. <br /> A F,tA;4(,47Y,11&?)s RCRWR" Ri%V3TTr.$0t_1El,11410.S 4,V0, A`at#.ATt011l r? Eft 400 P :008 r)Li111h V,I <br /> z 2. <br /> ua <br /> t9 <br /> 3. <br /> k: <br /> 4. <br /> 14.Speclal Handling Instructions and Addltlonal Information <br /> 4'ix0F%V_# 113371 54-tg) A11IATR.'3Pi FULL tM3t,f E.'ikli h,.T+Qk i�. l <br /> F-WR4GE;,NC'Y C`0iA TAGV: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION; 1 hereby declare That the contents of this consignment are fully and accurately doseribed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are In all respacts in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I oertifythat the waste minimization statement ldanfified In 40-CFR 262.27(a)(if I am-a largo quantity generator)or(b)(if I am a small quantity generator)is 1rue:e <br /> Generate s10[feror's Printed/Typed Name Signature `y. Month Day <br /> 3 <br /> ' r <br /> •J 16.Enternafional Shipmenfs ». - • <br /> l° ❑Import to U.S. ❑Expert from U.S. Port of entrylmdt: <br /> Transporter signature(far exports only)' Date leaving U.S.: <br /> W 17.TransporterAcknowledgmant of Receipt of Materials <br /> LU LU Trans ¢e Print y.ed Name yr Sig a urg M` , Month Day Year <br /> IL <br /> r � - <br /> A {W, r r 7" <br /> zTFansporter 2 PrinledfTypod Name "Signature Mdnth `Da f _Year <br /> r- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑'Quanti Type ty ❑ yp ❑Residue F]Partial Rejection ❑Full Rejection <br /> 11 Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S EPA ID Number <br /> Zi <br /> 0 <br /> Facility's Phone: <br /> Luu 18c.Signature efAlternate Facility(or Generator) Month Day Year <br /> Q <br /> s <br /> 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3• Notice: State of California requires <br /> generator to photocopy and mail to <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted In Item 188 DTSC wit0 days. <br /> PrIntedlTyped Name Signature P.0 Box 400 <br /> Sacramento, CA 95812-0400 <br /> EPA Farm 8700-22(Rev,12-17) Previous editions are obsolete. GENERATOR'S WITiAL COPY <br />