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rrr"s.rci•,n tJNs•.,rirrnn.ors•r t,,\p_::_:rt <br /> O `�yrJl�`,rs rlr <br /> Page I of 4 <br /> } r . <br /> / Please Pnnl w ypc lFumi desi na4 fa usa ' , F, AVf arW OW <br /> 1-05 <br /> — <br /> / UNIFORM N'�'\RDOUB r DenoraYv lDNulm ar:pllrbl l pawrdar l P O SKS 1 <br /> w'ASTE MANIFEST .,' . Pe94 I°' ',EmngI1R5. ala+.w° ^�^`. <br /> r �^n,mr.Na,„a a„u uaui,q neae,. a.aa . +ewmsw ma�nam.n mvn mwm9 aavewl <br /> ^en)rurY Phvee. "' ' ' U 5 EPA IO NrMaDer <br /> V 5 EPA ID Number <br /> F TmnSporto.2 Cwnlwny Name <br /> U 5 EPA ID Num00� <br /> 8 Doar9nand Facility Nema ora SilaAWmss <br /> Fac14ry'S Plrona. - \ <br /> 9a96.U.S DOT Lbscnpuon pncled,n9 Pmper Shlppr19 Name,Harard Class.In Number. In.Comaalers 11 Total ;last¢ <br /> TYf+a Ouantny <br /> � HAI and Pecking G..glans)/ Nn I <br /> O <br /> K _ <br /> W '0' <br /> W <br /> � w <br /> c9 — <br /> I � ' <br /> 4 lv Special HantlDng IIsriccrlens and Additional Information <br /> 15 GENERATOR'SrOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shlppmg name,and are classified.pacxaged. <br /> marked and labeledrplacarded.and are in all respects in proper condition for transport according to applicable international and national governmental regulations.It export shipment and I am the Primary <br /> Exporter I certify that the contents of this consignment conform to the terms of the allached EPA Acknowledgment of Consent. <br /> I cerlify 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 /> It <br /> Generafor'srOBeror's Pi inred/Typed Name Signature t.lonlh Day YealInternationaShipments <br /> Import to U.S. ❑Export from U.S. Pon of entrylexit: <br /> — Transorter signature(for exports only): Date leaving U.Sw17 Transporter Acknowledgment of Receipt of Materials <br /> OTransporter 1 Prinfed/Typed Name Signature Month Day ea; <br /> Q Transporter 2 Printed/Typed Name Month Day Yeac <br /> Signaturer <br /> I F <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑Quantity ❑Type E]Residue ❑Pallial Rejection ❑Pull Rejection <br /> Y <br /> F– <br /> J <br /> v Manifest Reference Number <br /> LL 18b.Alternate Fa lity jor Generator; U.S.EPA ID Number <br /> O =r <br /> W V <br /> q LL Facility's Phone: - <br /> LIJ18c.Signature o/Alternate Facility(or Generator) hinnth Day Year <br /> Q <br /> J�l <br /> / Z <br /> ig Haza dous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal.and recycling systems) <br /> / 1 _ <br /> fs4 r 2 3 4 <br /> I Tf <br /> 20.Designated Facility Owner or Operator.Cemficalion of receipt of hazardous materials covered by the manifest except as noted In Item 18a <br /> FAf PrintedTyped Name _r <br /> Month Day�Year <br /> EPA form 8700 22(Rev.3-05) Previous editions are obsolete. -- <br /> GENERATOR'S INITIAL COPY" <br />