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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) '-Foan Aproved'OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator(D Number 2.Page 1 of 3.Emergency Response PhoneTE MANIF _7Wa­ni1es1,Tra Tracking Number <br /> APO <br /> WAS EST NJ" _I J <br /> 5.Generator's Name and Mailing Address Generator's Site Address(If different than mailing address) <br /> Generators Phone:.. <br /> 6.Transporter 1 Company Name 7_7 U,S,EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S,EPA ID Number <br /> Facility's Phone: <br /> 9a. 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 0 <br /> 2 <br /> Uj . <br /> CD <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> K, TIC <br /> 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, <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 EPA Acknowledgment 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 aria small quantity generator)Is true. <br /> Gen�eytor Offerors PrintedrTyped Name Signature " Month Day Year <br /> 16.Intemational Shipments <br /> F_ F-1 import to U.S. El Export Port of entry/exit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> UW 17.Transporter Acknowledgment of Receipt of Materials <br /> 0 Transporter 1 Printed/Typed Name--- <br /> Month Day Year <br /> Z Transporter 2 PrintedtTyped Name Y <br /> Signature,,— Month Djy Year <br /> 18.Discrepancy <br /> Ise.Discrepancy Indication Space El Quantity El Type F-1 Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,S.EPA ID Number <br /> U<. Facility's Phone: <br /> U0 18c.Signature of Alternate Facility(or Generator) <br /> Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous waste treatment,disposal, <br /> and recycling systems) <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.-3-05) Previous editions are obsolete. <br /> TRANSPORTER'S COPY <br />