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:?x 4- t,3 arrarscrRe +as 7 r—F• --TA <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest racking Number <br /> Oft <br /> WASTE MANIFESTXe <br /> , ,<; � "°t..� ' <br /> JJK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 411 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address rM1��,�Q .,� w..AL. �. <t`�";"` U.S.EPA ID Number <br /> aft�� M•�a:�,�'��t' ,e''�� '���C f c��„�n�a'�'� �' '' ;�a� <br /> t 3-7,i ce O"'C <br /> Facility's Phone: <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> 11.Total 12.Unit9a. <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol.1. <br /> 13.Waste Codes <br /> N "V5R> M j., MMS �.r. � 1w <br /> DERERIJ <br /> * +��'' 2.`,�4 ,kt ;q {w''lC�.' �• iA" rf i •�7 I4m chi 7,N N.''., ;a?'3.4,'. ''f ' 'r fra.tiy.,y ¢ r <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Informations � y <br /> 95 G P-fia lam,-: tom' +roy al !gt_ �+ USE <br /> i���+ �v 1 i g <br /> Y 7IAM ILE �,�7 Tom+.'.•SE 1r%'�ii•W8 A*,-'0'&��45s�'ew6.''t!h”�R'��I S�C��ilPt"3.3:^P P '. <br /> E4'"'a t b 4 x. .npa!,.. ;.+ .w f�v i.r. r a. `r+.°N ° '' *'2 ;Y-�"� ,;•r..+r� _ ,t X <br /> r <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,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 EPA Acknowledgment of Consent. <br /> I certify 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 small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> J 16.International Shipments Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> i w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> t <br /> ® -. rf <br /> .7 r .� 1.u,:.s. �%` ��.. `�.rn��.,w �ta� .e' _ .•YkCk+!i,Mi<�... R%'wu wy�++`t 'Y <br /> z Transporter 2 Printed/Typed Name Signature Month Day Year <br />- t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Qua' <br /> ypej <br /> y ❑T ❑Residue F]Partial Rejection F-1 Full Re ejection <br /> r Manifest Reference.Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> u- Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> ca19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJI1 2. 3 4 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPT( <br />