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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Foran Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 • Generator ID Number 2, Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number , WASTE MANIFEST {: A Co 0 6 i 1 . . � , : � , _ - r I F , . JJK 5. Generators Name and Mailing Address Generators Site Address ('d different than mailing address) il : .�, �.' + I 'OAV1 TOWING , INC 178 ::10 :XI UTH wLAL I'P.Ri .W.0 " AN , T Jt, GPq 96336 Generator's Phone: ,trey q33' 1 ' -&. Transporter 1 Company Name + U .S. EPA ID Number Tl � rKTpAC F;CPVICFS ,3 .� I I 0 -7 7. Transporter 2 Company Name U.S. EPA ID Number bYi )RMWIF41 RE{'(.':WRY SYSTEM MC . f: A R 0 0 01. 1 .15422 8, Designated Facility Name and Site Address U.S. EPA ID Number 6500 OSf HIGHWAY 9! rNIA Sr ' • A1'. Rt') 00521. 14 ( i Facility's Phone: 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 ('d any)) No. Type Quantity Wtivol. lid (414 • :c; I;A HAZARM)US VI .3ftltlE'7 tCw - i E j w Z 2. 3. 4. 14, Special Handling Instructions and Additional Information i: MER{3ENCY r. ONTACT - CHF MTRFC 7 ;x424 !N00WOFS T' MMINAL GrRM C5 NAFRGO 981 7. 71 * FnonI E RR1 ALL69146 623NM OW( !2PI I17S APPRoPrIATE PPI' R101PMF, NT Y 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 classified, 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 tie attached EPAAcl nowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(x) (if I am a large quantity generator) or (b) (if l am a small quantity generator) is true. Generators/Offerors Printedrryped Name Signature Month Day Year 16. International Shipments ❑ Import to U.S. ❑ Export from U.S, Port of entry/exit z Transporter signature (for exports only): Date leaving U .S.: W 17, Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedrTyped Name Signature Month Day Year O a QTrnsporier 2 Printed!Typed Name Signature Month Day Year W t- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U ua- Facility's Phone: L ' 18c. Signature of Altemate Facility (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (is., codes for hazardous waste treatment, disposal, and recycling systems) Cn G 1 , 2. 3, 4. 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day lar EPA Form 8700-22 (Rev. 3.05) Previous edltlons are obsolete. GENERATOWS INITIAL COPY