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OCD Please print or type,(Form designed for use on elite(12•Fwindh)typewriter,) Form Approverl OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Ma fe�[Trac 1 Kumj�er� WASTE MANIFEST � .r' fVi c (J]CJ]1 L FLE-1 5.Genaralor's Flame and Mailing Address Generatots Site AddfeS4(If dlfferenl than mailing address) FOLD t.A9EL AT DOTTED a 1� i �B�F�ti,r,.i■y SIDE. of TO RIGHT' M �1P+ 5iDf Of HAZilR0011S M �� T TAB s7iC S 01 SD THAT s� o TABSTICIi50ilT. �N Generator's Pilone. 11L1 oiwrvOu'v+++�•iMmv sw� A.Transporter 1 Company Name U.S.EPA ID Number A*Armd i Dan" rt Inc. i 1 7.Transporter 2 Company Name U.S.EPA ID Number 8 bms,gnaled Faallty Name and Site Address U.S.EPA ID Number r e h s NV73MMOM Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. Immall1wEnlriomswwoks"KLLox ramsem D l P =1 NJ X Sai�lo■�. .P!>r _i Z 2- LU c9 1 3 14, J 14.Special Handling Instructions and Addlllonal Informallon P111111*9 IWII DKWMWA lk In 1 1y~71; 0M3n5DJM www 15. GENERATOR'SIOFFEROR'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 intemational 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generatpr)or(b)(if I am a small quantity generator)is true. Gen SJOIT sPTi tildrrype a bigna ire monthe A . -J 101rithri Shipments / ' I— ❑Import to U.S. ❑Export from U.S. Port 6f entry/exit: U Z Transporter signature for exports only): Date leaving U.S.: C9 17.Transporter Acknowledgment of Receipt of terials � Tr iter P yp4d Na gna onl r CL �� a IA Qransporter 2 PrinledlTypad Name Si at Month Day ear H 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: LO 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. � 2. F 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTypedNarw SignalMonth Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STA (IF REQUIRED)