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<br />18; Discrepancy
<br />M ..�.....•. �,�.�r,: �, ,� „,�; �, „, _, 4..:� .�.�.. , _. . _ _ : ,_" �. • _ .
<br />Quantity LJ Type Residue Partial Rejection E:I Full Rejection
<br />Manifest Reference Number:
<br />18b, Alternate Facility (or Generator)
<br />� U.S. EPA ID Number
<br />pFacility's Phone: a r• � `
<br />� 180. Signature of Aitergate Facility (or Generator)- ..,- •" Month Day Year
<br />� 19. Hazardous Waste Report Management Method Qgdasegdes,for hazardgug waste freatrlient,dleposal,.and recycling systems) '
<br />2. 3; A:
<br />20. De _gna ed Facility Ow er or Operator. Certification of Iplof hazardous materials covered by the manifest except as noted in Item 18a
<br />Printed(iype Nam. SignatQE ure.. Month Day Year
<br />EPA Form 8700.22 -05) Previ s aril are obsolete. NATED FACILI GENERATOR
<br />ole sa rint or pe, (Form designed for use ori elite 12 Itch pewrfter.):Form Aroved OMB No 2050-0039
<br />UNIFORM HAZARD US
<br />1'; Generetor ID Number
<br />2. Page 1 bf
<br />3, Emergency Response Phone
<br />4. Manifest Traa ng um r
<br />WASTE MANIFEST
<br />wi-Mailing
<br />fui�f�t� ��",.��� S
<br />�
<br />1
<br />1-800-468-1760
<br />SKS
<br />0024592
<br />5. Generator's Name and Address Generator's Site Address (if different than mailing address) -30
<br />wix'(b( t"t�.tTf.?..ff.j`IGH ',"iER�Y�°CE6 t�if3.OP i-'�':�B�t.g:,a`� f�.N .}I...r`#4�If::'"M
<br />aj ,.fir• .) 1, r?, r:�aq ts. R.. -C, I._
<br />a ?.� 4�d :ff~a? rdr..a at's i `'Cd a.•aT( 51,1 t '3, !�:rM, (�s � RQ4-,I r °f
<br />oaf t ; s1�'t C, f?�.�b:10S PO BOX ;180
<br />Generator's Phone: u — —Z °d fs la .1oly r ti:�;,:, ,.�nr;:,
<br />6. Transporter Company Name U.S. EPA ID Number
<br />E -,'A' ...f,�.,.:.f� #...l:_►, N SYSTEMS, ST'i�`t°€S, � NG,
<br />7. Transporter 2 Company Name U.S: EPA ID Number
<br />8. Designated Faculty Name and Site AddrodsIS,FPA, D Number _..
<br />.6 9 £ .. T t�C .. ., J.
<br />6At,x Aii`1(E.NT( r C.t"i tJ��,i S;J'oR0
<br />y'y
<br />Facility's Phone: Is 91," , !.r$+:yf!(ai,a�, G
<br />ga•
<br />9b. U.S; DOT Description (including Proper Shipping Name, H rd Class, ID N bar,
<br />10, Co tainera
<br />11, Total
<br />12• Unit
<br />HM
<br />and Packing Group (If any)) x' ,a
<br />Quantity
<br />WkNol,
<br />13. Waste Codes
<br />No
<br />Type
<br />Q�,
<br />1:
<br />{t'`. E"�d�'!.Ir.��v ��E..t,.2�Y'g�Er.t '4aa .i��`., t ..., �'r G.i .',.;.,
<br />;,;c 'j
<br />§tA.{r
<br />C 11"
<br />x_
<br />2L-`
<br />z
<br />2.
<br />u.r
<br />ca
<br />3.
<br />4
<br />4' -Spec at Handling lnsJructlons and A dit ono Information
<br />y..?.
<br />f0,1, 4.
<br />r.
<br />flR
<br />i�AlfPtit..%.f'�I(.-�i`.�-",,.i�lD�.k,..,?�.a�ti�.,.a,�r'''x�O (,.13A-TY`„MI;1,.
<br />a a r ; ;., c; -r-
<br />15. G AT f A' ERT CA : I ere y eolare at the contents of s cons gnment ora y and accurately deacr d above by the proper shipping name, and are classified, packaged,
<br />"are
<br />marked and labelRdlpiacarded, end in all respects In proper condition for transport according to applicable tnietnationaj and national governmental regulations. if export shipment and I am the Primary
<br />Exporter, I certify that the contents of this'c n'slgnment conform tq the terms of the attached EPAAcknowledgmant 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 am a small quantity generator) is true.
<br />Genaretorsl0fferora;PrinteatIypedMrne igrfatura Month Day Year
<br />r
<br />(=
<br />16. ntematlonal Ipments. r�-1
<br />®Import to U.S. LJ Export from U.S. Po q entrylexit:
<br />z
<br />Transporter signature (for exports only): Date leaving U•S,:
<br />ix UJI17,
<br />Transports ,Ae ant of Receipt of Materials
<br />a
<br />O
<br />Transporter PrintadlType ame Signature Month Day Year
<br />_ . _. � I I •, I a7,,.
<br />r..
<br />18; Discrepancy
<br />M ..�.....•. �,�.�r,: �, ,� „,�; �, „, _, 4..:� .�.�.. , _. . _ _ : ,_" �. • _ .
<br />Quantity LJ Type Residue Partial Rejection E:I Full Rejection
<br />Manifest Reference Number:
<br />18b, Alternate Facility (or Generator)
<br />� U.S. EPA ID Number
<br />pFacility's Phone: a r• � `
<br />� 180. Signature of Aitergate Facility (or Generator)- ..,- •" Month Day Year
<br />� 19. Hazardous Waste Report Management Method Qgdasegdes,for hazardgug waste freatrlient,dleposal,.and recycling systems) '
<br />2. 3; A:
<br />20. De _gna ed Facility Ow er or Operator. Certification of Iplof hazardous materials covered by the manifest except as noted in Item 18a
<br />Printed(iype Nam. SignatQE ure.. Month Day Year
<br />EPA Form 8700.22 -05) Previ s aril are obsolete. NATED FACILI GENERATOR
<br />
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