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Form Approved."QMB Np. <br /> PleSse.print or type.(Form designed for use on elite5(e 2 pit h)tygeVfrlter) r rr ri 2 a ge 1,of 3 Emergency Res 9nse Phone 4.Man)es did umber <br /> UNIFOR Rf)OU5 1.Gene�wiay'ID Num n a �. �' J J K <br /> NI.HAZA zv$ <br /> WASTE MAMFE5T <br /> 5 Ge ieratoYs NaiP and Mailing Address Generators Site Addr ,(if different than mailing address) <br /> �. <br /> ewu il,Y <br /> ,. is ,' <br /> Generator s Phone: U.SEPA(D'I3um4e�;; <br /> &Transpo 1e!liCor(SpatMlVe me <br /> E, O5>�EPiDNumber <br /> �— f s <br /> 7 Transporter 2 Company Name f 777"o ... <br /> F? r�€ i ,4( 3' o" F <br /> 61 <br /> U.S EPQrI�`.Number „> <br /> $ Designated Facility Na'merand Srte Address`' <br /> 4., <br /> Facility`s Phone <br /> 777 !7 <br /> 9b UJS.DO F,Dek,6ption(including Proper Shipping Name,Flazard Class ID tVumba[y 10,Containers 31 Total .12-Unit <br /> 13:-Waste Codes <br /> 9a. No Type Quantity Wt Not. <br /> HM and Packing Group(if any)) <br /> _ m <br /> LU <br /> z 2 <br /> 3 <br /> .; .7 s <br /> 14 5p'ecta�Ha6dhpg <br /> it] al Informatton `I tx,,•.v- <br /> tents of chis const riment are fully and acegratdy described above;by the proper shipping iatne o 2a <br /> and are olass f�ed�;packaged <br /> 15. GENERATOR 81I tROR S CERTIFICATION i;l hereby declare thatthe con . . .. g. <br /> c"riled-and are in a�res ects.m'proper condition for transpoit accord�ngao applicable lniematronal:and riationai govemme'ntai regulations ff export shipment and I am ifre;Pnmary <br /> marked antl.lat>eledlpla a. P. <br /> Ex crter..l.eertify that�the contents of:this cansignme t conform to.the�terms efthe atiac}ted EPA Acknowledgment of Consent uanti enehator is true, <br /> P <br /> i eertify thatahe waste minimuatlan"statement ideAdQ in:40,CFR 262.27(8).(if i:arri a'Eatgg quantify generator)oC(6j(if I am a sma I.q tY g ) "-. Montit�: Da Year: <br /> GeneratotslDfferdrs PnnfedlTed Naeie f� Signatures�,� r,�'* �� f <br /> 18.intemationaf 5hrpment5 Export from U.S, Port of entryleAt• <br /> F LJImport toiU:S Date leaving U S <br /> Transporter signature[for experts only): <br /> 17.IrensporterAeknowledgmen of Re 'Pt gwatedals <br /> g , *r Month .Day Yep <br /> LLJk <br /> TransporteY 1;'PrftttedfTj ped Name a « ry ; <br /> Signature: <br /> O <br /> r <br /> r <br /> irarispbrter u #r Signature <br /> lTped Nae x % d {2'nnted <br /> s <br /> Cr <br /> 18.:Ofscrepancy - � y' <br /> 1$a,Disc <br /> re and Indication S ace -. e ❑Residue ❑Pallial Retectioa ❑Full Refeef�on <br /> P Y P ❑ Quantify TYP. , <br /> ManifestReferenee Number <br /> U <br /> 18b.Alternate Facility(or Generator) 5 EPA ip Number <br /> .. <br /> rat FacilitysPhonei Month Day Year <br /> 18c.Signature of Alterriate Facilq,(or Generator) <br /> .19.Hazardous Waste Reporl[W nagement Method Codes'(Le.,codes for hazardous waste treatment'd sposai arid recyeting systems} <br /> w �. 2 <br /> a <br /> G S <br /> 20.De.aEgriated Facllty Owner or.operator Ce¢ification of receipt of hazardous matedals covered byithe manifest except as noted in Item.1.8p, on <br /> RRnfedlT ed Name; Signature <br /> 'Month Day Year <br /> Yp.. <br /> EPA-Form 8700-22(Rev.3-05) Previous editions are obsolete TRANSPOR'TER'S COM <br />