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Please prat or type, Form designed for use of elite(12-pitch)typewriter.) Form Approved,OMB No,2050.0039 UNIFORM HAZARDOUS 1.Generater ID Number 2,Page t of 1 3.Emergency Response Phone 4.ManifestTraddng Number �/��! WASTE MANIFEST 000197618 1 v 1 Y Y I 5.Generator's Name and MaAsgAddress Ge xxalors Site Address(•d different than mailing address) r. . Generators Friona: 6,Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Name and Site Address U.S.EPA ID Number FadII s Ptiome'. 9a 96.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Padang Grasp(f any)) No. Type Quantity wtAool. Z 2. W t? �•- 3. 4. :d r„ r i 14,Special Handing Instructions and Tonal Information CIA— a•. .I. i't'.. t', , .. ! is ,'.ic .. ,. .. . ,. 15. GENERATOWSfOFFEROR'S CERTIFICATION: I hereby declare that the corgis of this consignment are fully and accurately described eve by the proper shipping name,and are classified,packaged, marked arid labeledlplaceded,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 terms of the attached EPAAcknowledgme nt of Consent I catty 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 ell quantity generator)is true. Gai or'slOfteror's PrintediTyped Name Signature Month Day +Year ' ) t r; Intonational Shipment ❑Import to U.S. El Export from U.S. Part of entryleadt: Transporter signature(for exports only): Date leaving U.S.: 17.TrarspDrterAcl nowledgmentof Receiptof Materials Trti)nsporter 1 Printedll'yped Nara Signature Month Day Y� Z Transporter 2 PrintedJTyped Name Signature Month Day Year 18.Disorqpancy 18s.Discrepancy Indicates Space 0 Quantity ❑Type ❑Residxs ❑Partial Rejed. ❑Ful Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V I Facility's Phone: W 18c.Signature of A temate Facility(or Generator) Matth Day Year +t7c Z H19.Hazardous Waste Report Management Meth Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 1, 2. 3. 4. 20.Designated Facility Dinner or Operator.Certf ication of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printecirryped Name Sigiature Month Day Year EPA Form 8700.22(Rev.3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY