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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> HAZARDOUS 1.Generator ID Number 2.Page 1 3.E;-1refgeIicyPppons7 Phone 4.Manifest Tracking Number <br /> UNIFORM HAV <br /> WASTE MANIFESTI - 3-3 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different thappaitg address) <br /> r2 <br /> ",-1 - -' 5 <br /> OF T RFA IE'."' E-o V,il— 0 <br /> EP E <br /> ATTN 515H AINES <br /> U4 9*53,•76 `iii <br /> Generators Phone: <br /> U.S.EPA ID Number TXKRI'6004 84r.21-H, <br /> -TF s L.- <br /> Can,onnulcy <br /> 7.Transporter 2 Company Name U.S.EPA 113 Number <br /> 8,Designated Facility Name and Site Address C-LE'At'l 1 -BUTTONWILLOU. LL-' U.S.EPA ID Number <br /> 16 59 5 2-500 LI�111i-EMN R I I'A I Y <br /> Facility's Phone: <br /> 9a, 91b,U.S.DOT Description(including 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 Quantity WtJVol. <br /> 'S. - 1 223 <br /> 1-NOME� RrCRNP F1P7PkRD1T..;:3 CMILTij <br /> ol o —F— <br /> LLJ <br /> 2. <br /> LU <br /> 0 <br /> 4. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information SK, r1HI, i3C'_i51, 1.13-17 2 0 EY8 <br /> <: <br /> A HIP. UIERCiENUY 411-80,0-4 15-8-1760 <br /> C� 1Z - Z ' -"F- Y31 AG MECES-61:71RY <br /> Sr; Fir,11'H 0 R 17 E D- 0 R E 10 1 N1 L'.CE N' E I) ,-v Q <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents off&+vmW"wft*,w 46*9 mccuratety described above by the proper shipping flame,and are classified,packaged, <br /> matRed and labeled/placarded,and are In all respects in proper condition for transport raii-4%a it ~4millonal 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 atUld <br /> I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a OW Wmew -i%(if I am a small quantity generator),is[rue. <br /> GenerjatofsJOfferofs Prnteffl'yped Name <br /> Month Day Year <br /> A11.AA,' A? L) Z I /:-Jew 1 zrli <br /> =-I 16.Inteniatimial Shipments <br /> to <br /> Elimport U.S'. ❑Ew V.-4 Pont of e,trylexil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17 TranaporlerAcknowledgment of Receipt of Materials <br /> Y <br /> Transporter I Pdntedqyped.NameMopth Day ear.. <br /> 0 4 <br /> ua <br /> CL 1 )3 <br /> Y <br /> Month Day <br /> Traotporter 2 PfintedrrypeQpke.. Year <br /> + 18.Discrepancy <br /> 18a.Discrepancy Indication Space auantily 0 Type ❑Residue ❑Partial Rejection El Full R-election <br /> WArdesl Reference Number. <br /> 18b.Alternate. Facility(or Generator) U.S.EPA ID'Number <br /> reQ Faclilly's Phone: Year <br /> Month Day <br /> Lu 18c.Signature of Alternate Facility(or Generator) <br /> CD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and nicyclIng systems)y3 <br /> M <br /> UJI I 1 2 3. 4. <br /> 1 . <br /> --.. -1 -7- <br /> 20.detiW-ted Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest e4ciept as noted in Item lea <br /> PrintedlTyped,N pay <br /> Sig-,bj,* i year <br /> IF <br /> DES -AC <br /> EPA Form!B700-22'(Rev,'3-05)'Previous editions are obsolete. ILIT'M G"WRAR)R <br /> IqN TED IF <br />