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_ Please print or type. - Form Approved, OMB No. 250-0039 ' - t- UNIFORM HAZARDOUS .,Generator ID Number 2 Page 1 of 3. Emergency Resp Phone 4. Manifest Tracking Number - q - WASTE MANIFEST CARD OT sib` E , i Cp .3^ u`: S 000 2 � 6�5. .i 4) i;�' DAT 1, Generators Name a d Matling Address f s ¢q; iM1,'"t t ''u 3�%T?w Ge tors Site Ad1re,8g1 different Ilan mailing address) 11 7' Unlifd If5`"ia2l Dr0V°icr T€ 90d ran tfrei f*hxii11 _ Tr€mir Generator's Phone: +7^3z 6. Transporter i Company Name - - - U.S. EPA ID Number lff Tt nT 1� ftY T� }..: r;aE I Fk t, •C c> Ci t4 ;i' nD EaE w} t C.kLIIVl Mf 7. Trans orter2Com yN me U.S. EPA ID Number (Trans ftritrr�t °s4 ssr;~ss CAMSZZ rSe 8. D,,eeggignaaled F al l Nffl d Site Add - U.S. EPA ID Number --- Fac litys Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers ii . Total 12. Unit 13. Waste Codes HM and Packing Group litany)) No. Type Quantity ViABOL _-.& t. _ '. _ C, ha .r,,s, i oJV- t— w Z 2. W - CD 3. 4. r 14. Special Handling Instructions and Additional naformatfonqrSa pBa 0151841 J .. alno ."3. 5' !X) E- DrTeiVA oretxaeinm>YZCp aAtoMSVatrirt a ., t'vpll_I , er ilIfo ct.t .:Vhthl3 caSTtr7,aus fszn4jr x i-PA ha {,. G,1,...i - - 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 labeledlplacarded, and are in all respects in proper condition for iransporl according to applicable international and national governmental regulations. It expert shipment and l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm nt of Consent. - I certify that the waste minimization statemgnt identified in 40 CFR 262.27Ra (if l am a large quantity gengtaf) or (b)(ifI am a small quan illy generator) is ue. r Generators/Offerors P ntd/Typed Nam \2 . /- - Sigmfmre ', ! / `—� - 100 Ih Day Year 16. International Shiprrients ' F ❑ Import to U.S. 9 ❑ Export from U.S. Port of entry/exit: ? Transporter signature (for exports only):; - - - Dale leaving U.S.: w17. Transporter Acknowledgment of Receipt of Materials r �—,r ; f�f - ' 1— Transporter 1 PrintedlTyped Name Signature /' /j' " Month Day Year Z Trpponter,2&PdntedlT ped Name r(�i,�`t �^-/f f (� Signatl "s , Mo th D/ay Year el71 r 1 EE .. . Discrepancy. _ ..—__._.._ 18. 18a. Discrepancy Indication Space [I Quantity Residue❑ T Pe -- _� - --- ___�---- y ❑ .. ❑ Partial Reject) ❑ Full Rejection Manifest Reference Number: r 18b. Alternate Facility (or Generator) _ U.S. EPA ID Number J LL Facility's Phone: - - w 18c. Signature of Alternate Facility (or Generator) _ - Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 20. Designated Facility Owner or Operator: Cerfification of recelpT71lassf mus materials covered byjhe manifest except as nded in Item 18a Printed/Typed Name p /'� �/ Signature i' r' M nth Day YearEPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. `" DESIGNATED FACIIITYTO GENERATOR