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D <br /> 0 0 N N <br /> Z ;I � N � <br /> Please Form Approved.OMB No.2050Aa39 '' O <br /> D Ur pi--pant w!Pp IFo m ile5rclnad uSe ea B 112-PIIGh)Iypew IeY} 2 Page I nl 3.Fmergency Response Ph... d Manilesi Tracking Namber ` {�/ <br /> t.�re,arorm Number rfa;,l n_.r fi'V JJi� <br /> CD <br /> UNIFORM HAZP.RDOl15 <br /> D WASTE MANIFEST ;t' GBneretaYs Sae Adtlresa hrd FBranl than mailing adore%s) ~' (D <br /> z e20rJ'sf�me and ANIM9 Adtlress O <br /> jrjPERls11 TR )I YY' 3M42 W — <br /> c MakTecu <br /> E tienenbfs Won® U S EPA ID Num4?.r ` N D <br /> E Transpormr!Company Name <br /> WCfM n OIL FNVW <br /> US F,VAID Number <br /> J 7 TranspoMr2Compeny Name <br /> a WCaRLDWT0V RFCC''-I O 0 <br /> q 0-e qu-wd Fa-wly NemB and Sire Andres U.5-EPA1❑Number � <br /> "FS MANAl,1111A'NT INC <br /> .,'.OU 05 1-uGHWAY 925 <br /> IIMA l !f to <br /> Facility's Plwne' EW—A^. "�' It <br /> ab.U S.Dor-o piption(indudsry Proper 5hipping Name,Hazard Class.ID Number 10.Containers 11.Total )2 Und 13.Waste Codes M <br /> 9a. No. Type Q-0y VYtivol. 3 <br /> HM and Packing Group fir any 11 <br /> O (D <br /> a l <br /> w 2 <br /> 00 <br /> Lrlw <br /> 0 <br /> N <br /> lD <br /> a � <br /> O <br /> 14.Speaai Fiar,;;crp-.r=_x�-ror;acn anerncnal lnfomra6cn � <br /> fD <br /> i MF M <br /> fD <br /> 15. GFNER4TOR'SVFFEROR'S CERTIFICATION:I hereby declare fhaf the comenls dl Mrs consignment are fully and aocurateVy deschhed atwve by the proper shLpp irg name.and are dassi5ed,packaged, <br /> marrr.j arrd ra0eledrFraraMed.and are in ail respecfs in proper omdIbon for transport according ro applicable intemallonaland national govemmental regulations.It export shipment and 4 am She Primary r-t <br /> Fxpon-1 c Ayy Nal Ina—sews of this consignment conform to the terms of the attached EPAMknowledgment of Consent. <br /> I certify mar rhe waste minimization statement identified in 40 CFR 282.27(x)lit I am a large quantity generator)or(b)lift am a small quantity generator)is true, O <br /> Generarors'r7flero/s PrinledTyped Name Signature Month Day Year rt <br /> 16 lntemabonal Shipments <br /> ❑import to U.S. ❑Export from U S. Port of entrylexit: (D <br /> Transporter signature(for eAporla only): Date leaving U S.L'j : • <br /> � 17.7ranspbrterAdmowledgment of Receipt of Materials O <br /> Tr-anspon'er)PdnledlTyped Name Signature Month Day Year <br /> a CL <br /> rn Manlh Day Year r"1 <br /> Signature <br /> Z Transporter 2 Printed/Typed Name I, O <br /> .< a <br /> I <br /> I— <br /> t8 Discrepancy <br /> 18a.Dlsaepancy Indication Space Quantity ElType ❑Residue ❑Partial Re�eciion ❑Full Rejection <br /> Manifest Reletence Number: <br /> lab.Alternate Facility(or Generator) U.S.EPA ID NurnGsr <br /> J_ <br /> Facility's Phone. <br /> W 18c.Signature of Wlemate Facility(or Genaratof) <br /> z <br /> 19.Hazafdot s Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> CD <br /> O n <br /> O <br /> 20 Designated Fadlity Owner or Operator:Cerlifitahon of receipt of hazardous materials covered by the manifest except as nod,in item 18a N Q <br /> PriMea7yped Name Signature <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> O <br /> v W <br /> (D N <br /> A <br /> O <br /> W <br /> O <br />