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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 FUN:1F0Rk!JL4dl DOUS1 . Concision ID Number 2. Page 1 of 3.'Emergency Resp Phone 4 Manifest Tr I g Number /ry�r ®/'1�TIC STE FEST t 111 ^ 73 1 (1 00 ; + ,„ I t .. ['Name dMailing Addess 4'( 1 / kk. h � ( i :a, Generators Site Add (if different than mailing address) Gr1f r U t .= ck Fi . . _ Ila 1 7 61 Generators Phone:. ; b' = i 'D�'4 � 6. Transporter 1 Company Name U.S. EPA ID Number Ila; let( fat ffi' 1 .l: t:I?'i 11 j"""'Ei I P k :1, IDIi, I)ITaft 1 ( e'Ir 7. Transporter 2 Company Name U.S. EPA ID Number DII!C, J Efi ,Fcxvi riff E E :cws h ):`scar : _A 8. Designated Facility Name and Site Address U.S. EPA ID Number ( n !tt I( 4k".G)i , - i ;4 raft FI i -i' ! d Facilltys Phone: no. 91h. 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 Not. of 1 I14n': / , _ , d_ (,' (,!11 1 L2:E ) 0 —' L 2LutI -. - k A'-;tr lt . s4:'rLl +uitl ( G'�{ I c� -•- -�---� I 3. --_ s_ _ 4. I 14. Special Handling Instructions and Additional Information 1 d, ,,_t. Fiats, lI i , enx: , R fi• a_ C faalter.-fu, 1 , 1.r i,x;3at 1 z 1 , ;:rfC5 tc �ukr a aiq , t, . .Ui e>:1 t t ^s .:: , a , k I I .:irii i a 15. GENERATORVOFFEROR'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 Iabeledlplacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I faulty that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I county that the waste minimization statement identified in 40 CFR 262.27(a) (if ; am a large quantity generator) or (b) (if l am a small quantity generator) is true. GeneratorslOfferorIs Prnted/fyped Name Signature Month Day Year F16, International Shipments ❑ Import to U.S. ❑ Export from U.S. Pod of entrylexit: Z Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknovdedgment of Recti lof Materials Transporter Printed/Typed flame - Signature IL - Month Day Year a l L, f QTransporter Printed/typed Name Signature,. Month Day Year a � r l8. Discrepancy 18a. Discrepancy indication Space ❑ Quantity ❑Type ❑ Residue Elul Rejection ❑ Full Rejection Manifest Reference Number: F 186. Alternate Facility (or Generator) U.S. EPA ID Number J U w Facility's Phone: w 18c. Signature of Alternate facility (of Generator) Month Day Year Q Z On 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) w 1 . 2. 3. 4. 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covered by the manifest except as need in Item IBe 1 Prntedrryped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR 'S INITIAL COPY