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FROM : L.F.W. MFG. INC. FAX NO. : 209 465 G521 #9 <br />Mar. 14 2007 07:50AM P2 <br />��� <br />EPA Form 8700-22 (Rev. 3-05) Pravious ediUcing are QbSoleW, GENERATOR'S INITIAL COPY <br />tiv, VIVID No, ZUW4)W� <br />WASTE MANIPFST <br />JJK <br />5. Gonaratoes Name and Mailing Address Generators Site Adiriss (if -different than mailing soaress) <br />Generators Phone; <br />6. Transporter I Company Name US, EPA ID Number <br />1. Transporter 2 Company Name U,S. EPA ID Number <br />8, Designated Fadlily Name and Site Address t U,S. EPA 10 Number <br />Facility's Phone: <br />9b. VS, DOT Desciiptlon (Including Proper Shipping Name, Hazard Class, 0 Number, 10. Contalnem 11. Total 12. Unit <br />HM and Packing Group (d any)) No. Quantity ".ft. 13,V4" Codes <br />77 0 <br />LU <br />4. <br />14. Special Handling InstrUctions and Additional Informail6n­ <br />-77 <br />1E. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately 0301>ed obovo by the proper shipping name, and PrO!6assffied, paclwgod. <br />marked and labelediplecarded, and are In all mpeM in proper CoMiticri for transport according to applicable international and natioh�l goyernmental regulations. If expon shipment *Kd, I On the PlimAry <br />Exporter, I certilythatthe contents of1his corisignmont conform to the tenns ofthe attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization ARtemont identified in 40 CFR 262.27(s) (KI 3M 8 large quantity generator) or (hk(if I am a small quantity generato* is true. <br />GeneratceslOfferors Pi Signature morm bay Year <br />16. International Shipments <br />import to U.S, Export from U.S. Port of entry/exit: <br />Tiranvorw signature (for exports onty): Do leaving <br />E ag <br />17. TransporterAcknaivIedgment of Receipt of Materials <br />Signature <br />Transporter 1 Prtnteday"d Nan* Month Day Year <br />A. <br />Tran"r 2 PrintedlTyped Name Signature Month Day Year <br />18. Discrepancy <br />IU DIscrepanry Indication Space F� oamity Type Residue Partial Rejection Full Rjisclkin <br />MAriffost Reference Number. <br />18b, Alternate Facility (or GeneraV) U.S. EPA ID Number <br />Fadifty's Phone: <br />18Q' Signature of Allernoto Facility (or Gimerstor) '�'L�jlne <br />Mcnth Day Year <br />I a, Nilardous Waste Report Management Method -Codes­(j,e., ood es.4 Orkwardous waste treatment, disposal, and recycling sysitims) <br />20. Designated Facility Owner or VoraW; (�Irttltcauon or receipt or riazardous, materfsW covered by tne manitess except as noted in ItBrn lea <br />"Wyood Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Pravious ediUcing are QbSoleW, GENERATOR'S INITIAL COPY <br />