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FIma pent or type.(Form designed far use on elite P pewriter,y Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS i.Ge rater ID Number 2 Page 1 of 3.Emergency Response Phone 4.MadJ <br /> st Trot l Num <br /> WASTE MANIFEST (� � �,. 70Z _ Q 4— - (3 8 7 9 2 2 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> w t 1\: -Ak► -�-,.�n1� I thC5 <br /> Generator's Phone. 4 Q <br /> 6 Transporer 1 Company Name U.S.EPA ID Number <br /> George 14. Lowrif,Inc. <br /> 7,Ianparer 2 Company Name ' U.S.EPA ID Number <br /> E'DaPl�7�IRA. YAN ress U.S.EPA�O�lumhec,c; ; <br /> 273ZEi= iSt <br /> � .�"�," w <br /> YUMIA,Al 85365 <br /> Facility's Phone 42c--344-9$18 <br /> ge 9b.U.S DOT Descrption(including Proper Shipping Name,Hazard Class ID Number, 10.Containers it.Total 12.Unit <br /> Htt and Packing Group(i'any)j 13 Waste Codes <br /> No Type Quantity WtN01 <br /> Y 1. fJfttr! FC". li-IA2APDOUS WASTIE: (oily absorterit &dietits) DIM <br /> t:J <br /> Z 2 <br /> LU <br /> C5 <br /> 3 <br /> 4 <br /> 14,Sff�ajg Instruc0ons and Additional Information <br /> USE GLOVE~ ` ���' !PIJOICE <br /> 15 GENERATOR'WOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping nam,and are classified.packaged, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAc1mowIe^ent of Consent. <br /> ertify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity ge rat or(b)(if I a a small quan g tor)is true. <br /> t <br /> G ne r'sioffe* PrintediTy a, S natu Month Day Year <br /> r l to17-`111 <br /> ..J 16. ntemational S =pments <br /> 1— ❑Import to U S. ❑Export from U.S. Port of entry!exit: ._ <br /> Transporter signature ifor exports only) ofng U.S.. <br /> L t 7 Transporter Acknowledgment of Receipt of Materials <br /> L= <br /> Transporter 1 Pnnted,Type Name Al <br /> S gnaturo Month Day Year <br /> Cn t l� Zy <br /> F T iter 2 Pcinte��d Name/ Signature Month DayYaar <br /> Q t 1-7 <br /> 2 Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quan0 <br /> ! ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> !19b,AltPmate Fac, Manifest Reference Number: <br /> lity,(or Generator) <br /> U.S.EPA ID Number <br /> L)( <br /> LL I Facility's Phone <br /> l u 118c.Signature of Aftemate Facility(or Generator) Month Day Year <br /> I y 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> !LAA ca 2 3. 4. <br /> '20.Designated Facility Owner or or Ce cation of receipt hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />