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310 se print or.type. Form Apprm <br /> UNIFORM HAZARDOUS '1.Generator ID Number 12.Page 1 of 8.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE"MANIFEST �. <br /> 5.GP�nerlatgrs iia e pn '7afl AdJtSsp Generator's Site Address(if differentttian mailing address) <br /> Lt �w r ! r szr.iwai h9 12r;"t� ? <br /> •�t���,��:3r�� €�"Y mak, �.5. <br /> Generator's Rhone. ` NF1 a <br /> 8:Transporter 1 Company',Name U S.'EPA)D,Number., <br /> r' <br /> Geei <br /> 7.Tian porter 2 Company Namey U S EPA ID Numi;er <br /> B.Dpl,, aced Gil �1 me anp Site litdress U.S:EPA1f7 Number <br /> f { [R�tla: <br /> r<aS:`E �'. t'FSt,v9Ellw'`4� <br /> Fadilltys Phone:.041:12 'W <br /> f' <br /> 9a. and Pac DOT Description(iriclud€ng Proper Shipping Name Hazard Class ID Number 10 Containers <br /> 9b U:S: <br /> HM ang Group,(if any)) 11.Tat 12,Un t 13 Waste Codes <br /> Total <br /> No Type Quantity W#.7Voi <br /> *` 1 n7,w TcTi. 3# 5?W 1 .. f i' r a e <br /> 1' <br /> z 2. <br /> Lij <br /> i. <br /> :a <br /> i <br /> f <br /> I. <br /> 3 <br /> 14 especial Ha ydling Instructions and Additional information f <br /> 15..`GENERATOR{S10FFEROR'S C£RTtFtCATtOW I haiebydec*e that.the contents of this consignment are fully and accurately described above by the proper shipping name,aid are classed acka ed'' <br /> p. - A , <br /> marked and'labetedlplacardetl,and in all"respects m proper condition for transpart accordingVapplicable intemaiaonal and national goveirnmenta#reguiations.l,lf.exportshipment and I ani the Primary f <br /> Exporter,I certify thatth e contents of this s consignment confotm'to the terms ofthe attacmed)PAAokncwledgment of Consent. <br /> I Certify that the waste:'mtnimizationsfatementidenUfied rn'4t)CFR 282.27(a)(if I am:a.targe auant'ity generator)or(b}{ift m a smaitquantiiy generatar):is tEue. <br /> GeneratoSlCifero�s PriniedfFyppd Name Sighatu e �a" ,r Month Day ' ;Year" <br /> � tea . I. <br /> 16.Intemational`Shi ments <br /> Import to <br /> U.S. O Export fromU,S. Port of entry/exit: <br /> Transporter signature(for exports only);, Date.ie hg U.S.: <br /> LF 17 Transporter"Actcnowledgment of Receipt of Materials <br /> Tans/r7erteGlPrtit,jfkp�edName Signatu� -� Month Day Yea <br /> LS„i^ <br /> f 4 <br /> (a Trans�iorter 2 PrinjjjtedlTypedName ,,. , .. ...Signature ' ✓ -: ".+ '.'Month DaY .Years'. <br /> 18:Discrepancy �, <br /> 18a.Discrepancy Ind Space {{j ' <br /> Quantity ❑TYp? L_i Residue Pariial:Rejection F6I1 Reiecton " <br /> Van!test:Reference Number <br /> 18b.Alternate Facilely(ar Generator) U.S.EPA ID Number <br /> 3 <br /> Fadliys Phone; <br /> 18c.Signature"ofNi rhatePacrlity(or"Goherator) <br /> Month`' D'ay Year - <br /> k19.Hazardous Waste PZ Pp t Management:Method Codes(i:e.,codes for hazardous waste:troaiment,:disposal,and,recycling systems) ..' . <br /> 2. <br /> 14. : <br /> 20,©es gnatotl Facility Owner or operatcr.Certification of receipt of hazardousmafenals:covered py the manifest,except as Helsel n item:lbs <br /> Printedlryped Name Signature " <br /> Month day Year <br /> i <br /> A Form 8700-22(Rev.12-17) Previous editions are obsolete, <br /> TRANSPORTER COPY <br />