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rn <br /> Co C0 <br /> L0 N <br /> O <br /> O <br /> = CO <br /> it <br /> T I <br /> Um1vnplA <br /> t3'Naste Codas, <br /> .m5 TYy° r`"'btl <br /> 0 <br /> U f <br /> _ <br /> Please print or type.(Form desmgned for use on elite(12-pitch)typewnter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Ganem r ID Number p.Page 1.113 Emergenq R­—Ph— a.Manirest Tracking Number ' <br /> WASTE MANIFEST 1 •1 a m ,, 71 I V <br /> 5 Gene24v.'s.Ndme,anq Mzilinq Address Generalofs SdeAndress nl d'"­1than mailing it—) I V\!I� <br /> Generalu's?none. <br /> 6.Tfans -I i.mpany Name U.S.EPA to Number <br /> 5 Transporter_i.ompanv Name U.S.EPA to Number <br /> 5 D-9.10 Fa Nl,Name., ante Adtlress U.S.EPA IDNumber <br /> Fa.w's Phone. <br /> ga 9b.U.5 DOT Descnrhon ordbovg Pmper Shipping Name.HanrE Class.10 Number. 10 containers 11.Total 12.Unit 13 Waste Codes -- <br /> HM and Parlino Groupmrfam:I Ne. Type Ouanrity wtvol <br /> � VeN <br /> ( O <br /> cz <br /> I <br /> w <br /> � y <br /> T <br /> D.,. <br /> — ta,Special Handling Instructions and Additional Information <br /> 0 <br /> GENE RATOR'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 classed,packaged, <br /> r marked and labeleelp-2ded,and are in all respects,in proper condition for transport according to applicable international and national governmental regulatbns.It <br /> export shipmem'and I am the Primary — <br /> Exporter,I certify that the contents of this consignment coMorm to the terms of the attached EPA Acknowledgment of Consent. <br /> T I cemfy Nat the male e minimization statement identified in 40 CFR 262.27(a)of I am a large quantity generator)or(b)(it 1 am a small quantity generator)is We. 1 <br /> Q Gefleralols/Olferols Pnnted(Typed Name Signature Mnn1n Day Year <br /> 0 (r <br /> U w 16.International Shipments ❑ <br /> ~ Import to U.S ❑Export from U S. Pon of enbxit <br /> y/e <br /> 0 Z Transporter signature(for exports only). Date leaving U.S.: <br /> -0 w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter I Pnnled(Typed Name Signature Month Day Year <br /> � � O <br /> aiMonth Day Year <br /> z Transporter PdntedlTyped Name Signature <br /> � a <br /> C � <br /> fq 'x 18.Discrepancy <br /> 1 <br /> I 163 <br /> .Discrepancy indication Space El Quantity _T r.e 1:1 Residue El Partial Rejection ❑Full Rejection <br /> E <br /> Y Manifest Reference Number. <br /> 7 <br /> U.S.EPA ID Number <br /> 16b.AAemale Facility(or Generatorl <br /> J <br /> � U <br /> C'7 LL Faclliys Phone: <br /> LO l w 18c.Sgnalure ofAltemate Facility(or Generators Month Gay Year <br /> N I, a <br /> Lr) C4 z <br /> 0') 2 <br /> T15.Hazafdvus'Waste Pepert Management Method Codes 11 e v,des for hazardous waste treatment,disposal,and recycling systems) <br /> Q W 1 2, 3, <br /> a <br /> U m <br /> C 20.Designated Facility Owner of Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item IBa <br /> Signature Month Day Ye a1 <br /> � PrinledrTyped Name g <br /> U <br /> 0 fn <br /> U EPA Form 8700.22(Rev.3-05)PfeVIOUS editions are obsolete. GENERATOR'S INITIAL COPY <br /> Ca <br /> 2!2 <br /> 0 = lyd[E <br /> 00 <br /> X00 D <br /> N 0 U <br /> N = <br /> � corn <br />