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01 <br /> Please print or :(Form designed for use on elite(12-fit)typewriter.) Form Approved.ON%O.20 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.1wi-ttestTracting Number : <br /> -WASTE-MANIFEST 4r taa>�>*cES�'% 1 . s�r?11 '?1 s< s e :•.� <br /> S.Generators Name�a)nd Malting Address Generator's Site Address(d different than maNq address) a <br /> P;9. SON aka' a1Citt s <br /> STOCKTO.GO 9&V6 <br /> Gen..toes Phone X71 .2{1012 <br /> 6.T r 1 Name US EPA 0 Number <br /> _or <br /> n, EGE VE <br /> 7.TranspMar 2 Company No" U.S.EPA ID Number <br /> S EPA ID Number <br /> 1620 E.MLRMAGE..Uf C.At X-C1'F12 7k, <br /> l AKERVZ, s ly ENVIRONMENTAL <br /> Fe s Ptor,a"` ;:::,. LTH DI PARTMENT'..: <br /> 9a.. 13.Wass Codes <br /> qb U:S.D07 Descripdon Qnduding ProperShgipirg Name H :Gass fb,,Nuipbar . . . . ...A0..CohWners:..... 11.Total 12.Unit <br /> yM' :.and packing Group(dam) t rt .. . No. Type Qu@ntity WtNol.. <br /> 4,4GA; f{tr A FtA7.ARDOLDS k ASTI-2. 96.iL,fi1 I,r3:b_Y AB f.q'M3 l 4 S{ <br /> W 2. <br /> 5 <br /> 3. <br /> 4: <br /> 14.Spade]Hander Instructions and Additional Inform f ) <br /> W.Ue171 �� SST tri tateE � ' <br /> 15. GENERATOR'SIQFFEROR'S CERTIFICATION:I hereby dire pial the contents of this consignment am fully and accurately desc�ed above by the proper stripping name;aril are classibed,packaged, <br /> marted'arnd'. d,and are in all respects In'proper condition for bort aowrdng to a0mble fntemaftnai and nationg governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that theca tents of this consignment conform to the terms ofthe attached EPAACIVIOMedgmt of Consent. <br /> cetti(y that the waste minimization statement Identified in 49 CFR 26227(s)(dl am a,large quantdy generator)or(b)(if lam g,gtnag q 11ty genaretar)Is true. <br /> a0ffe"PrfntediTyped Name Mordh Day Year <br /> —r 16.tntemodonal Shipments ❑Export fin <br /> in U.S. Port of entrylexit" <br /> F ❑import to-u.S.. <br /> z Transporter signature(far exports only): Dai leaving U.S.:. <br /> 17.Transporter of Mate <br /> Transporter 1 Pdntedityped Name. Si , _7 Month Day Year <br /> 7.1 <br /> Transporter 2 PriMed07yped Nate Month Day Year <br /> F <br /> 18,Discrepancy <br /> 18a.Diss;ancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pard R*dlon ❑Fug Rejection <br /> Manifest Reference Number. <br /> 18b.A@emate Facility(or Generator) U.S.EPA ID Number <br /> raw Facility's"Phorre::. <br /> W 18c.Signature ofAltemate,Facility(o erator) Molt Day Year <br /> a • <br /> z <br /> 19.Hazardlous Waste Report Management Method Cotes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> fl t f U1 <br /> 2 3. 4, <br /> 20.Designated Facer owner or Operator:Coocation of recut of hazardous materials covered by the modest except as octad i�.Ue¢t3 @a <br /> Ptrhtedf f Nine f d ( 1 J ; Signature to rYe — <br /> w. .Sri'. ;�.i ✓dr t `' _1 � p <br /> �Y <br /> EPA Form 8700-22(R&3.05) Previous editions are obsolete. i r' ANSPO RT•ERt'S COPY <br />