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Please pr€nt orfype, i <br /> Form Approved OMB No.2050-0039 <br /> UNIFORM HAZIdF3Q0U_S 1.Generator ID Number '2.-Page 1'6f::: 3 ErryerenqResponse Phpne 4 ManlfesC Tracking Number <br /> 11ldASTE M64NIFBST , ' ;:a$:j " _ 7 ta�f 1 .x� ag C U :tette. <br /> 5 Generators Name and Mailing Address ~' r z t <br /> R `�t enetator'sssSite'A_ddress(i#different than maTrg address) <br /> _ :"„yr�y �'-P7 r.-_ , r . <br /> 4 <br /> Generators Phone: <br /> 6.Transporter 1 Company Name' U.S.EPA ID Number <br /> ry^: �..nF o w v$:b`'t4.� '.'�."' �A ,�,ib.:e,;<' I•�1a;.'y b1,.,:�. .�v {- �'. <br /> 7 Transporler 2 Company Name U.S.EPA ID Number <br /> „ r [ gg_ <br /> 8.Designated Facility Name and Site Address <br /> US EPAIDNumber <br /> ph..,.,µ ,, ., <br /> 24 <br /> Facility's Phonet) - <br /> ga 9b..U.S.DOT Description(inoiuding ProperShipping Name;Hazard Class 10 Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.lvol. II <br /> ?a <br /> 4: <br /> e� <br /> Z 2 Kt s <br /> 3 <br /> a <br /> 14 Special Handling Instructions and Additional Information <br /> .H3 qtr 9y��;�.'-�T 6:°�^ -d5 ..!-4a� i'�aa.fi.'. NF1 --; w',..7n`. <br /> 15. G8P]ERAT0R1S10FFER6R1S CERTIFICATIr]lV: I hereby declarethat the contents of this consignment are fully and accurately,described abpve by the proper:shipping name,and are classified,packaged, <br /> marked and,labeledlplacarded,and are in all respects in proper condition for transport according to appfcable intemalional and national governmental regulations.If export shipment and lam the Primary <br /> Exporter,I certify that the'contenisof this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste m#nimizatior statementidentified 16 40CFR 262,27(a),(f I am.6 large quantity generator)or,(b)(if I-am a small quanfity generator)is true. <br /> Ga;ratodslOfferors PnntedlTyped Name 91gfSaf7 h ? r T Month Day Year <br /> 1� <br /> 16.1nternatonal Ship menu W t? <br /> ❑[mporttoU:S. ❑Export from U.S. Pomo#ensrylexil: <br /> Transporter signature(for.exports only); Dateieaving U.S.: <br /> LU <br /> ,17.TransporterAcknowledgmentofRecejptafMaterials <br /> Transporter 1 Printed/Typed Name natures Month Day Year <br /> g.ry / S^ r <br /> Transporter 2 PnntedlTyped.Name Si nature 1 1' <br /> 9 / F Month Day Year <br /> 1 ;'2 r;..-.. r e.''%.1/� r�'�',,1`"t.•'""J_ �..r�t,+r�� :�� `-� .Jy,r L .!��/ �..-r'�' <br /> 18.Discrepanoy <br /> 18e.Discrepancy Indication Space, <br /> Quantity ❑Type ❑Residue ❑Partial Rejection ❑Pull Rbjection <br /> Manifest Reference Number., <br /> 18b.Ailernate Facility(or Generator) U.S.EPA ID Number <br /> cs <br /> Facility's Phone: <br /> Lj 18c.Signature efAlternate Facility(or Generator) A9ohth Day Year <br /> Z <br /> Co 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ® 1. 2. 3: 4. <br /> 20.Deeignaled'Facility Owner.or Operator:Certification-of receipt of hazardous materials covered by the•manlest except as noted in item 18a <br /> PrihtedlTyped Name- Sigriature; Month Day Year <br /> EPA Form.8700-22(Rev.12-17), Previous editions are:obsolete:, <br />