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�15 -'A Please pfint or type.(Form designed for use on elite(12-pitch tA*writer.) Form Approved.OMB No.205(�M 1.Generator ID Number 2.Page I of 4.Illardfost Traciting Number UNIFORM HA2AMUS WASTE MANIFEST 1006398713 SKS 5.GeneraWs Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: C Transporter I CoTpany lipme U.S.EPA ID Number M'l 7,Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Nam and Site Address �At'it'I's 44yE� f 4$ "Ar U.S.EPA ID Number L Facility's Phone: ga. 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Num11K 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Pecking Group(d any)) No. Type Quantity WIL/Vol. 2. LU 3. 4. 14.Special Handling Instructions and Additional Information f 15. GENERATOWStOFFERORIS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping ram,ami are classified,packaged, marked and labetedfoacarded,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=form to the terms of the attached F-PAAcknowfedgment 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)(41 am a small quantity generator)is hm Generalor'stOfferor's Printedrryped Nam Signature Month Day Year r-i 16.International Shipments F-1 low to U.S. ❑Export from U.S, Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: 17.TiransporterAcknowledgment of Receipt of Materials W Transporter I Printed/Typed Name Signature Month Day Year !.CC Tirwporter 2 Prmted/Typd Name Signature Mort Day Year f5 I 1 1 18.Discrepancy I as.Discrepancy Indication Space El Quantity El Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. tab.AttIwIwe r.dwy for 6�tor) U.S.FPA 10 N—k-, ca Facility's Phone: c3 TEE Signature of Alternate Facility(or Generator) UA Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste trieuminent,disposal,and recycling systems) UJ I 2. 3. 4. 20,Designated Facility Owner of OperaW.Cerdeabon of receipt of hazardous materials covered by the manifest except as noted in rem 18a Printodirryped Name Signature Morith Day Tear— EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY