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rn <br /> I C0 <br /> L0 N <br /> LID O <br /> O <br /> ry- awcnwla.,.,.,..-._ C: (978)Sbu•Sr ra — --� r <br /> n tbum93rdnef@wtpe.com F: (209)323.7329 re ly <br /> � _ www.wlpe.com � <br /> 0 aaeal,w•Bmeklpn weM c.^•-". f � <br /> -O —— <br /> o <br /> rr <br /> Please prinl ur ype.(Form designed for use on 0079 <br /> UNIFORM HAZARDOUS 1 GnnnmMr ID ellle 112-ilchl IYpewrner.) <br /> oved OMB No.2050 <br /> WASTE Numhnr Ponnm pr JJK <br /> MANIFEST <br /> S G n raNr's N A l l 1 r - 2 Pn11n l n1 J.En,-„enn A.Mon�M TMu7 tl Nn — <br /> "nl <br /> ,nen, mnlrp annro.ai <br /> ,SII <br /> lionemlols Phone: <br /> 6.Tra"po,le11 Compan`Nan, <br /> I , uaEPA to con„m., <br /> 7.Trensponer 2 cum's”Ngn,r. <br /> �UN-•,Ir,:V,l,) ;, Il`.EPA ID rWn,lr, ' <br /> a.DPt199Wiba Iviicuty Faire and s.-ndara:, <br /> - Irl iii vus Ew.lo Hu„b,, <br /> !Mq <br /> Fa-Hys Phone: - <br /> cd <br /> 99. 9b.US.DOT Description(mrlud,ng Proper Sheppm7 Num-,Hazard class.ID Number. tit.Conamers 11 Total 12.Und I I Waste <br /> I and Pgrklnn Greup 1,l anyll 0 anbly `Nr Vo' S <br /> No TYp- <br /> � ' o <br /> z <br /> � 7 <br /> T <br /> 1 <br /> U <br /> � CZ <br /> d <br /> O <br /> � )� 14.Special Handling lnsbudbns andAddifional In/ormalion <br /> 0 <br /> 15. GENERATOR'S10i'l CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,ant are classiLed.packaged. <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable'mtemational and national governmental regulations.it expon shipment and I am the Pnmary <br /> Ex,rI rernly that the contents of this consignment conform to the terms of the attached EPA Acknowledgncenl of Consent. <br /> fMI the waste minimization statement identified In 40 CFR 26227(a)(if I am a large quantity generator)or(b)(itI am a small quantity generator)is true. <br /> T <br /> Year <br /> Generalocs/Offerocs Printed/Typed Name signature <br /> R1onN Day <br /> Q <br /> 0 -1 16,International Shipments import to U.S. Export from U.SPon of ent�'❑ . lexa: <br /> U F— ❑ <br /> _ = Transporter signature(tor exports only): Dale leaving IO w 17.TmnsporterAcknovdedgmenl of Receipt of Materials <br /> 22 T2nspor�r f Printed,Typed Name` signalure, ,'1 Month Day Year <br /> C °• I 1, - ` <br /> aZ Transporter Month Da Prinledrryped Name Signature y Year <br /> 18.Discrepancy 11 <br /> i 118a.Discrepancy Indication Space ❑Quantity J T,:,- ❑Residue ❑Partial Rejection ❑Full Rejection <br /> _D <br /> c <br /> C Manifest Reference Number: <br /> Y18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> 7 <br /> � �J <br /> V , <br /> 0) LL Facility's Phone: <br /> r\ 18c Signature ofAltemate Facility(or Generator) Month Day Year <br /> w <br /> LO CD a <br /> Q Tr <br /> N N19.Hazardous Waste Report Management Method Codes(i e..codes for hazardous waste treatment,disposal,and recycling systems) 1 <br /> L0 2 3. <br /> 0') <br /> U m <br /> 20.Designated Facility Owner or Operator:Ceni(icauon of receipt of hazardous materials covered by the manifest <br /> goatueecept as noted in Item 18a <br /> Month Day Year <br /> E PrintedfrypedName <br /> O =3 <br /> U <br /> GENERATOR'S INITIAL COPY <br /> O O in EPA Form 8700.22(Rev.3-05)Previous editions are obsolete. <br /> U U CD <br /> Urn ca <br /> i L LI <br /> Uo0 0 <br /> � LZ <br /> CY) NO U <br /> N = <br /> � � rn <br />