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Pleasepdfit or type. Farm Approved.OMB No.2050-0039 UNIFORVHAL4RDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number WASTEMANIFES7 JJ K- 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: 6.Transporter 1 Company Name rr ��yy U.5.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number e.Designated Facility Name and Site Address U.S.EPA ID Number Facility's Phone: r 80` 4 4` 1 '} 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt-fVol. O2. w w 4. ��. �-AR 'lett'; Wit 1-IT-9,310 14.Special Handling Instructions and Additional Information VE CLOTHRIG i; T $ rig: 111M 4 41 11111121 '1111 i N 11A I$ d A, 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged, marked and labeiedlplacarded,and are in all respects in proper condlEcri for transport according to applicable international and national governmental regulat€ors.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 CFR 262.27(a)(if i am a large quantity generator)or(b)(ifI am a smell quantity generator)is true. ,GeneratorsiOfferoes PrintedfTyped;Name Signature Month-- Day Year ,` _j 116.International Shipments p_ ❑Impart to U.S. ❑Export from U.S. Port of entrylexkt: z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU 6� TransporteYTP`rntediTypgd Name Signature Month Day y Year CL U) Transporter 2 Printedrfyped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantic Type Quantity ❑ yp ❑Residue ❑Aartiat Rejection El Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ U LL Facility's Phone' W18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(La.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materals covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY