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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 1.Generator ID Number Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Numb r y WASTE MANIFEST ah ,�>k y �� 5.Generator's Name and Mailing Address ' (Alk I uk Di.'EJGE ON(: Generator's Site Address(if different than mailing address) .1333 AoTiLl UN SFR C€PUE Generator's Phone: ''09 477- 6.Transporter 1 Company Name 40$4b OL,EiIIVIi?rr,_'MMIENTASERVICES U.S.EPA ID Number 7.Transporter 2 Company Name 3 6 U.S.EPA ID Number 8.Designated Facility Name and Site Address 3 EChI,' U.S.EPA ID Number 6,3703 Stu t't€*i rt L df',Nflif i)f Facility's Phone: :"" ^77 3: t C A�0 9 7 0.3{'3 9 9 w3 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit No. Type Quantity Wt.Nol. 13.Waste Codes 1. vv 4' k ATHE O Z 2. w c7 3. 4. "t 14.Special Handling Instructions and Additional Information i /y�q p �p � y 9��t /a q y �y ''• 9-:',. .�i'tF i ii kJl3�'! :! ,4"sX.R+"4�d:.^Y raVld R'f i .GSTr$tSMP�..6..CrEF F'S 5 5, �`'�%"1.�:..I'4G*981. 71 �,pp TC ")949RO SPA I"IATHE` HCt"JIt3MS *P-.'00-O 78 .50 AAePf?nPRIATF PPE EQUIPMf;ld` 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year -r 16.International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature a Month Day Year co Z Transporter2Printed/IypedName Signature F Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 ❑Full Rejection Number: 18b.Alternate Facility(or Generator) Manifest Reference NumU.S.EPA ID Number J U �a+ Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Q Month Day Year Z W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 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. GENERATOR'S INITIAL COPY