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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved, OMB No, 2050-0039 <br /> UNIFORM HAZARDOUS 1 . 9eqf r torli N m er, ) 2. Page 1 of 3,tFIiQn s PN Shone 4. Manifest Tracking Number <br /> WASTE MANIF016870187 <br /> 88 JJ K <br /> 5. G nBr tQr Nall" and Mailing Address Generator's Site Address ( f different than mailing address) <br /> L" 56 8- RIwttKMAPA Pir <br /> Generators Phone: <br /> 6. Trar��pore } on)�arylNa e{9JP4i'fll fITAI Ai > <br /> ,' FD umr2710 ,i z <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. D9il4n?tP4-F?Gill y,f� % <br /> a a di it , ss <br /> a U.S. EPA ID Number <br /> `5 M 701 V1 Buylilc AVUAW <br /> Facility's Phone: 500 ' <br /> 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> HM and Packing Group (if any)) 13. Waste Codes <br /> _ No. Type Quantity Wt.Nol. <br /> 0 <br /> z 2. <br /> C9 <br /> 7 <br /> i <br /> 3. <br /> MI F <br /> 41, <br /> 14. Special Handling Instructions and Additional Information <br /> r61C t . s_ i: fflL —1, . � -'� i'•"•� 1. t3tj. fut . .'� ' { - z Ya }, i n p - =" . ' ez ,3§ r� - - <br /> €J( , t L. 4 -4 ti <br /> P'tvl �—#fs.'-�lIN ' 9( 1 ) ?;It }€7r�v° <br /> , 3 ±'? i.. '( � <br /> 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, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemational and national govemmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (If I am a small quantity generator) is true. <br /> Generator's/Offeror's Printed/Typed Name Signature-.. Month Day. Year <br /> � <br /> J 16, International Shipments <br /> z ❑ import to U.S. ❑ Export from U.S. Port of entry/exit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. Transporter Acknowledgment of Receipt of Materials <br /> OTransporter 1 Printedrl yped Name Signature Month Day Year <br /> Q Transporter 2 PrintedfTyped Name Signature Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space <br /> Quantity ❑ Type ❑ Residue Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> _J <br /> V <br /> u. Facility's Phone: <br /> W 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> Q <br /> Z <br /> co <br /> 19. Hazardous Waste Report Management Method Codes (Le', codes for hazardous waste treatment, disposal, and recycling systems) <br /> LU 0 1 ' 21 3• 4. <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. ENERATOR INITIAL COP <br />