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<br />Form AoDroved, 01VIB No, 20550-0039
<br />77enera!Orit) Number Z Page of gencia Response Ph nc 1:4, �MamfestTrackinq 'Number
<br />UNIFORM HAZARDOUS -T
<br />WASTE MANIFEST 00795650`8 JJK
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<br />5. Generator.. Name and Maikig Adrifess Ger erators Site Add,,ess of nffew-t thar, macll,ng adidreis)
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<br />U'S ppil in NurrlLi"rp.
<br />acilitv Niarni; a,d S*1 Adldess S,
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<br />pacfliiv,VPhaRC:
<br />ti.s, oc�r nesuip� n lo-duding Pr('Pet�' SNPIQ;ng Hazaru Clas J0 Number.
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<br />'.3. iiilw codes
<br />,and Pa,, .l Gruo it
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<br />14, Special Handng {nstr cv ns and Additional Informattoii
<br />15GENERATOR.'SIOFFEROR'S CERTIFICATION: ' retyby declare that the contents ofthis cons:9 rimentarefullyand accuralalynscrjber abcve b> tl,,Ili .rope, spippv;a! arri are classified, packaged,
<br />marked and aridare it all ! espectsil", proper condition for transpol? according to Pprilicabie interna_, nal -an, oatbnal go, ern.nic r,1111 reoulations i? exp„ tmlpment and 1 arn the Primary
<br />Exporter-! CeO6 thpt the,"ontants of Irlis consignmen -onto ml to t e ter' 'is of the attached EPAA&,rDwtedgrnen!,jf Consent.
<br />C 262.27(a� (if am a large quantity generator) or �'b) "am a smill quar� goerator�
<br />i certify tPfat the waste statement derit:fied 1.9 40 CFR g ZrUe
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<br />n Stgnaiure
<br />lo eraugaiofferor��,- �medl! yried-Name Morth Dav Year
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<br />-j 16, inte-riatiora hips ienls 71
<br />J.110 -T to J.S.L--j ExPort f,,,)vn US .. .. ...... ...
<br />-ransiaortesignpluie Icor exports only;,
<br />17. Transporter; cknowledarnprit of ofMatetals
<br />. .. ......
<br />I-- -vood Name Month Day Yea�
<br />Transporter I P r"intedi'll. Signature
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<br />Z Transpose- Frim_ ilyped Name -rith Day Year
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<br />18. Dscfepat c%,,,
<br />18a, DiscrepancyInd! oalio rl spoe Full Rejeeticini
<br />Quantity !Vpe i Piairt.a! Rejeciion
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<br />Nianilat, Nunritri Reference r
<br />li 'or Gei-,crator1 US P�� 'D Number
<br />1 8b Alterriatc FacitY
<br />ILL. Facility's Phoric,
<br />a188, &gmiturr, c'A1tarrae Facili'y (or Generate; Month Day Year
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<br />0 19, Hazardous Was'e Rell klanawn-pn, Mlethod Codes 0 e., ociaesfor hazardous waste treatment, disposal and rpcvcling sy,!ems;
<br />1.
<br />2.
<br />4.
<br />t-�ilIt} filrat!or, of rpyeipl of hazardous by the rnanife 8a
<br />2OWr.lar Or OperafO_ CerlL
<br />Des
<br />01 qinaj Fac
<br />7'lrypS Sip.
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<br />EPA Form 8700-22 (Rev. 3-05' Previous editions _e obsoiete. f'.�,
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