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Please print or type.(Form designed for use on elite(12-pit typewriter.) • Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.Manifest Tracking Number WASTE MANIFEST CAC 0Qj' `�41 j4,� ` ojl/�r,. sf��• 77/r0 008745046 JJK 5.Generator's Name and Mailing Address ?7 �, 7,cJk"/f iD Generator s Site Address(If different than mailing address) 1•tr,jZ54.7-0 OJ A�"t/ r�'+� Generator's Phone: cP709-94i- ,cA0 6.Transporter 1 Company Name U.S.EPA ID Number 1,:�.4.,C000/1360EIVE D 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressU.S.EPA ID Number NOV 0 4 2013 .R A ��'�' [1enval ENVIRONMENTAL LTH aCrz't»C�KIC�, ,+9 pI PER rr/SERVICE Facility's Phone: /47 -a '�"`� "' „7 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit 13Waste C HM and Packing Group(H any)) No. Type Quantity Wt.Nol. . odes y rod 1. 0 o o / 7-79 � low:�Arn r�r✓ r-r-t s'rr a. r�+' ft7 ' 37 d �" 7•s�t Z 2. W t9 3. 4. 14.Special Handling Instructions and Additional Information r ��Z 134 .�� P"yu i� !� € o,..)o 6 5+Ia12 A43 e c b A) A n c P, 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)(d I am a large quantity generator)or(b)(f I am a small quantity generator)is true. Generator's/Offerors Printed/Typed Nage Signatu Month Day Year V 10 "C �t �- \,A"), G r r J 16.International Shipments i- ❑Import to .S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signatu ---- Month Day Year SL y zQ Transporter 2 Printecir typed Nam Signature ��" Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 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/T apse Signa t _ 1,.- - Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR