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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number p WASTE MANIFEST ! �_ ti_ i ,t:; f �� d G D F 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Names "' U.S.EPA ID Num er•, ?j:j$6 7 ' CU NG bi x�L.1ltt7 r r 8.Designated Facility Name and Site Address CIO . CJ U.S.EPA ID Number Facility's Phone: s_ ct. _._ •i:.,^ t t ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and PackingGroup(if aan''y))3y��vv��yy{ ��}��^^T7�q��gr�T'p ;��q x� No. Type Quantity Wt. Nol. QO 1. t`7FJS.`- i RA- f.XW Oy S A- r / ��r.�,�. 1-) Z 2. w 0 3. y; 4. 14.Special Handling Instructions and Additional Information 2FELEMMQ-1SO R TEE (ERA MROVED &�FETV- 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,': 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)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials LLI &�I Transporter 1 Printed(ryped Name Signature Month Day Year O a Z Transporter 2 Printed/Typed Name Signature Month Day Year F- 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 LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 55 U, 1 2. 3. 4. O 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba Prinie- yped Name Signature Month Day Year EPA Form 8700-U(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY