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lease print orForm Ap.pro '.J"d <br /> type. vut UNIFORM HAZARDOUS 1.Generator ID Number <br /> 2.Page I of 3.Emergency'Emergency'Response Phone 4.Manifest Trae,k'ng Number <br /> 1 <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generators Site Address(ildifferent than=17rigaddreSS) <br /> il0tien, -':"Zile Imnilial <br /> 1-01� ':� J*130VNW)f <br /> or, �1 e,Pt-21106 <br /> Generator's Phone: 204-234-770V -- <br /> 6.Transporter I Company Name U.S.EPA ID Numt%er <br /> 7 TianspnrteQ Company Name U.S.EPA iD Number <br /> 8 Designated Fazility Name and Site Address L 1.S,EPA 1 rJ N't;n 1 W, <br /> --,.-rogh 11 rit,1134;wtm% ri, <br /> 1.7-zil!,I Iv 09c"i'l <br /> Pacilty'sphone: 775-651-2'&'ti-,A —-- - -- . . <br /> I.D.Conmii Tota,ga ib.U.S.DOT Description(inctud ng Proper Shipping Name,Hazard Class,ID Numoer. <br /> HNI and Packing Gmup(it any)) No. TYPO <br /> 10 <br /> z <br /> LLI <br /> 4. <br /> 14,Special Handling Instructions and Addilianal Information <br /> PPE <br /> 15. GENERATOR'SOOFFEPOR'S CERTIFICATION: I hereby declare ilial the Contents of this Consignment are ful:v and accurately described above by the pmDershic* ,v <br /> marked and laboled/plararded.and are inal respects in proper condition(or transport according(Dapplicsble intem3lionaland Ii'lxP371 a7'; :i I <br /> Exporter.I Certify that the contents of this consignment confomi to We terms ofthe attached EtAAcknoMedgnr;ilaf,-,ciisent. <br /> i ce-Vity that the waste minimization statement identifed in 40 CFR 262.27(a)(if I am a large quantity generator)or f,b)(if I am a sm34 quanftj p-nt-ratorj is true. <br /> Generator's/Offerors Printed/Typed Name Signature Mcnih <br /> _j 16.Internal.'onal Shipments <br /> 0 import to U.S. El Expoa from U.S. PorlotenWexilc <br /> Transporter signature(for exports only): Date teeing U.S.: <br /> X 17.Transporter Ackiiowledgment of Receipt of Materials <br /> UJI <br /> TtansDodw I Pfintedfryped Name Signature <br /> 0 <br /> z TrunsportP.,2 Printed[Typed No Signature <br /> P <br /> 18 <br /> Ciscrew.-Y <br /> l8a Discrepancy Indication Space ❑ F7. <br /> I Quantly Type Residue LJ Partial RejF.-mw, i"; <br /> Man fest Reference:qu moar: <br /> lab.Afternai,Facility(w Generator) U.S.EPA 10 NL;Mbcf <br /> L<L Facilty's Phone: <br /> I&- sqnalijre cfAllema!e Facdly(or Generator) <br /> z <br /> in 19.H;170fdaus Wasto Report Management Method Codes(i.e..codes for hazardous viista treatment.d;3po-"d.w1o.acycirw?systems) <br /> LLS <br /> 4. <br /> ll <br /> 2%.Designated Facility Owner or Operator:Certification of receipt of hazardous malatials covered by the m3nifest oxonpt os noted in New 118o <br /> PrintedIT)rped Name <br /> Signature <br /> :PA Form 8700-22(Rev.12-17) Previous editions are obs*16. <br />