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;�„;r PI 'e print or type..(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-00394.Manifest Tracking Number 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 9 UNIFORM HAZARDOUS r r r j ,'�i;-!i')I - . 7 WASTE MANIFEST ar.xl, . .),aft ( s� � s 5.G ner tors N e a d.�9ailin Addrelss Generator's Site Address(if different than mailing address) r+�c'ra. ps , '�t+, c: �r:s °trait.d�Yri;;. �I4�rvf{SFr}a,t.i1,rt;;s tt>t•F.}.y J w ��O C'IiP:irZf t„"kr+a1��'t'L Generators Phone: U.S.EPA ID Number 6.Transporter 1 Company Name . :.: 'cm(jug:i0-`.qtr @i,;C;IP3�':t'E;'SI"s:rit�"r�°s'r'L�3h+;wi�r:•c.;s hlri:, U.S.EPA ID Number 7.Transporter 2 Company Name f , 'l I f (', '\'� U.S.EPA ID Number 8.pi3signasF y41Wftme and Site Address Facility's Phone: 5�s2•al s:!��1-ti5� 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. p t t.-s--tb t r "`taORd 17-k12 # 1.4Y - I. tt�i"t t%� ;.�1tk�Hlri�.l pm Z2. v, LUPint'eft`•:,Y�li�£rt4�J�.f7`r��:.il E�'trFrll� tii.rprfi�et=.' �v,�^q, fy _ P I I 3. t P 4. 14.Special Handling Instructions and Additional Information ,r �. ' !b61 Fo4ile, .6t-"f :l;• .ra°n �":.�,'4P '`+ Z ,�.r✓! 1,,,,,...:.I. 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classed,packaged, marked and labeled/placarded,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 EPA Acknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Month Dai Year GeneratorslOfferors.PrintediTy'd-Name Signature qQ ^y j 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexiti F- Date leaving U.S.: z Transporter signat5re(for exports only): d W 17.Transporter Acknowledgment of Receipt of Materials Month ' Day Year 12 Trans den Printed/Typed Name r I d Signature? :� � .,�•••°�°°� •w�^ Month Day Year z '¢ Tran�sfpowyter 2 Pritedfyped Name 7,,��., r.:•✓ t._.e -� ��I f int (/ I�— I- F C. All 18.Discrepancy El Full Rejection 18a.Discrepancy Indication Space ❑Type Residue Partial Rejection Quantity � r r.•i' '. ', C itE E1 CED wrisre WAS RECEIVED HANDLED AND sroRFD ,t •i,POSAL.TREATMENT OR REUSE THEMBY THE DEPARTMENT OF TOXIC SUBSTANCE CDNTROL�TOGET!F r U.S.EPA ID Number 18b.Alternate Facility(or Generator) lt1.UE E NVIRONMFN ,TAL PROTECTION AGENCY IN ACCORDANCE WMi THE PROVISIONS J fE RESOURCE CONSERVATION AND`RECOVERY ACT OF 1976 TOGETHER wrIH APPLICAB'• U EL?ERAL AND STATE REGULATIONS, CROSBY R OVERTON HAS ALL W Facility's Phone: ilRMITS TOA Month Day Year W 18c.Signature of Alternate Facility(d Y pA NAS BEEN HANDLES a Z RU 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month Day Year Printed/Typd Name; gnature Si EPA DSSBGNATED FACILITY TO GENERATORForm 8700-22(Rev.3-05) Previous editions are obsoldte. f' -