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Form Approved . OMB No, 2050-0039 Please print or type, 4. Manifest Number _ UNIFORM HAZARDOUS 1 . Generator 10 Number 2. Page 1 of 3. Emergency Response Phone r M g III _ VES�r WASTE MANIFEST r: u. E (i (i 7 f :i 1 1 c ) _ !: '' . , VES 5. Generators Name and Mailing Address r L; h ' Generators Site Address (H different than mailing address) i1r5r" 1 " r4 If :JET �zimUTH C �s Generator's Phone: U.S. EPA ID Number l 11111 6. Transporter CompanyPaine i3 D v `' +1 VZOI.,Tr<. 1.7.9 TE13141-11r_`tT. SOUTT1 1'Z U.S. EPA ID Number 7. Transporter 2 Company Name NEW Ell ty Address ; g ,I $L' ^ �.r Is' I. S _gT ,;.' iir' s•T U.S, EPAiDNumber Be Designated Facility Name and Site TT T 1 k; 4. Vii'. i (kl�r `1Y17, 1�. i`• °i l� [ G m [+- ;l �i t S,. µ Fadlil>rsPhone: L0 -` ; ; • 6VU 9b. U.S. OOT Description (including Proper Shipping Name, Hazard Class, ID Number, No Containers 11 . Total 12. Unit 13. Waste Codes 9a No Type Quantity Wt.Nol. HM and Packing Group (if any)) .� 1 . FTf'J3 '> ti ? PfClF .0SFVV SellOIf ID 3 QST !", Ii'lk-.� R'�` K1` If'. • 1 ' . r'S� �' H?T'Rk� T�� a Tui'', a . TiL ij ? P 2. -iJeIs, ,*r c he r4,} F ; •,- r i`: Yr' 2 -j+:'•-.tiY.. kL..• .�.,I'tr.'r 1_ 1 -dries •LU L+1 '•. { F6 I 11 Q u Po n ., :J: . _ jt ... 4. �.' (, • ,•lT� -•7 {� 5 L!Sv �I� r..�J:.' t`l C.t-L LtLGiened b;:. '='=i.L !'racu'_ _liT' Lw` r 14. NINE WE MINE= SpedalHandlinglnsWctionsandAdd�tionalinformatlon } . $_V � � �E - �R. h . 1 _ y: r . �-• � •iw , �23�,: `r (: 1 ' _ tt,rrf le Lir 540 ?optic oQri r 2) Lrr: r,..iCB r•, r ,^ E3r tG'Y'S i' rLSl.v i LJ i . • L! iL 1 Gt •`•^rs .'+ - . .1 i t l - • i (• -t:. 4 : ILI I yrn 7f i .Uir ` iJv31O 4kUSLt'((t1 4 ' ` U 0I* 4Y :. i �,` ` I S •i 'J lle- 15. GENERATOR'S10FFEROR'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ar d are classified, packaged, marked and labeledlplacarded, and are in all respects In proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment 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) (if i am a smelt quantity generator) Is true. year ne Signature , . Month Day GeratoeslOfferor's Printed(Typed Name } '' _ -- Ile 16, International Shipments ❑ Importto U.S. ❑ Export from U.S. Port ofentrylexit Transporter signature (far exports only): Date leaving U .S W 17. Transporter Acknowledgment of Receipt of MaterialsIIIEP Month Day Year LU Signature _ Transporter i pdntedTTyped Name __ _. • - J !t i i . . ❑•0 Month Day Year Z Transporter! Prmtedffyped Name Signature VIIII III,,t- 18. Discrepancy 18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue Partial Rejection Full Rejection Manifest Reference Number. OWN U.S. EPA ID Number 18b. Alternate Facility (or Generator) J ' �a Fadlitys Phone: NONE= n Day Year L0 18c. Signature of Altemate Facility (or Generator) Act ZMEMO= 11 a-i 19. Hazardous Waste Repo t Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 4 w 1 3. a 20. Designated Facility Owner or Operator. C ��j�G�?/ y manifest except as nded in Item 18a Month Day Year Printed/Typed Name Signature GENERATOR' S INITIAL COPY EPA Form 8700-22 (Rev. 12-M Previous 6