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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 ILr"zWASTE MANIFEST 4 JJ y c,3� V)A,f-, �00 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 IAr Uj'U!", 7.Transporter 2 Company Name..., U.S.EPA ID Number 8.Deqlgnateq?Fq0Iit V U.S.EPA ID Number y-,Np U/if 1`44 t71A to ref 1,11 "�l 11 cz ,i,,t if . j Facility's Phone: '"t 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 1.� 11.Tbl[A•: 11 Unit HM. and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 0 2. Uj 0 3. 4. 7- 14.S!� �i.ql Handlin nal Information Instructions and Additio 7, 15. GENEIRATOR'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,,',f, marked 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•cordly'tha't the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I-certify ffiat the waste minimization statement Identified ln40CFR 262.27(a)(if I am a large quantity generator)or(b)(if I arr-a small quantity generator)Is true. Generatoes/Offeroes Pdnted7yped Name Signature Month Day Year V .J 116.Intemational Shipments El import to U.S. ❑Export from U,S. Port of entry/exit: Transporter signature(for exports only): A Date leaving U.S 17.TransporterA&owledgment of Receipt of Materials ul A 0 Transporter.4-PO"0 Name Signkture N Month Day Year Trahsporter 2 Printedfryped Name Signatbr6V, Month Day., Year & 18.Discrepancy 18a,Discrepancy Indication Space El Quantity El Type F-1 Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number zi Facility's Phone: t Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year 19,Hazardous Waste Report Management Method Codes(i.e,,codes for hazardous waste treatment,disposal,and recycling systems) LU1. 2. 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 Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. TRANSPORTER'S COPY