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SK <br /> ``5 aPiaF'#� 229743624 <br /> RECEIVED BY SJCEHD-. <br /> Please print or type., 10/29/2019 <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number rTe77er�enpy Response Phone 4.Manifest Traaccking N°uumber (��[cWASTE MANIFEST i�t4t., 30 373509 � 8 0 �l .i SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 6830 ( <br /> Generator's Phone: ' '", - 'J <br /> 6.Transporter 1.Company NamemiT`I'h1.�� +(� <br /> U.S.EPA ID Number <br /> r <br /> 7.Transporter 2 Company Name <br /> 1 U.S.EPA ID Number <br /> -,(- <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> l't ; <br /> �3R�t�l� `1-E; � UT' 840292x;35 -884--8100 UTD9815321`7`7 <br /> Facility's Phone: , <br /> 9a• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol. 13.Waste Codes <br /> k 1 UI'1�ttz+t, , WQ STE E�+t�!�: t"14"�MENTALLY HAZARDOUS P q,343 <br /> o Ir)a t�4 ,,a ( tea r.1? WO. * , (4,4'-M THYI, <br /> ,1�6I='t OND WITH TH SCID I O (�;'„j <br /> Z 2 +#d��':06, J SUS` °F Ctijf R d SE1 P <br /> [u 0S.�pyy I(M y'T`OL Y I Lie_'N <br /> iro 1 Y <br /> ¢ AC 1 <br /> 3 Q1M 4'Nf 7 NON R( RO )l T! .. <br /> (44 <br /> a �l� <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD e AG <br /> ,; f s311 1' <br /> r" r ERG1. <br /> —1 rE0-E �, � ,'TFI Cont t hR3 Y E / � ;. . La"nf � y yt trtrconfers ane-neyauthor-' <br /> ninitial trans anterto �.Ad or sbait ,. , <br /> on Ml., <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: 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 EPAAcknowledgment 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 /> Gen r tq¢s/Offeror's Printed/Typed Name Signature Month Day Year <br /> 16.International ShipmentsP 4 <br /> i- 1:1 import to U.S. ❑Export from U.S. Port of entry/exit: <br /> K Transporter signature(for exports only): l Date leaving U.S.: <br /> W17.TransporterAcknowledgment of Receipt of Materials .,... <br /> Transporter 1 Printed/Typed Name Signature *� �.- Month Day Year <br /> ® k., ` / �f J <br /> � e� .ot ff 'Y . •4* `.e�fi'�C_..—�'P !' ':, �..,... ,t.✓ r�r"' �,,.. „„ f,.. <br /> ZTransporter 2 Printed/Type"Name Signature- Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Ouantit ❑Type y YP ❑Residue ❑Partial Rejection ❑Fufl Rejection <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. T <br /> 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 COPY <br /> 1)8jt?11. e_ .: d.t� M, #e 1.:34,/1`•3 19419 3)8727135/101F636 <br />