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Please print or type.(Form desl ned for use on elite(12-pitch)typewritor.) Farm Approved,OMB No.2050.0039' <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST ;16.g7r-�,,,t; JJK <br /> 5.Generators Name and MailingAddress Generalues SlfaAddress(if different than mailing address) <br /> ATLAS,=.a.fla'fil.lt•t <br /> 6 i 3- l if lt;,JE l"".t f cT <br /> Generator's Phone4'JJ'534&i'45 if <br /> S.Transporter i Company Name U.S.EPA ID NumFer <br /> 7,Transportsr 2 Company Name U 15 Number <br /> 0.Designated Facility Name and Site Address f s,.1�y> :(� l- � '1 , U.S:EPA ID Number <br /> Itt�. <br /> 1SiL s#at.tf}r 1�11h,F'rtt). « (;,u,;.~.t: a'<" <br /> Facility's Phone: , <br /> ga, Ob.U.S.DOT Description(Including ProperShfpphg Name,Hazard Class,ID Number, 10,Centelners 11,Total 12,Unit 13.Waste Codes <br /> HM and PackfngGroup Cif any)) No,, Type Quanuty wl.Nol.. <br /> 1 rw rr r. .nr,r>rvrtrsit kl.r , vur1,�rr yr_rrtra tr�rt !N'fJf;l Y <br /> 3"�- P rw <br /> s 2. <br /> Uj <br /> 4. <br /> 14,8eclat Handling Instructions and Additional information <br /> Uri <br /> f jWW!t fsrliSt�61h11 rf1'PL <br /> 1`0440LRIRS.;}iFiU4 t7 F7fi''Tr`?t I110i 4xtt7 USE AP9-R0VtJ0 PIPE' <br /> 18. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents ofthis consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, •. <br /> marked and labeledlplawded,and are in all respects in proper condition for transport acoording to applicable International and national governmental regulagans,If eiport shipment.and 1 am the primary <br /> Exporter,f certify that the contents of this consignment conform to the terms of the allabhed VAAcknowiedgment of Consent. <br /> I'certfly that the waste minimization statement identified In 40 CPR 262.27(a)(if tam a large quanlitygenerator)or(b)((Gfam a small quendty generator)Is Uve. <br /> Genoator'slOfferoesPrtnledfl'ypedName Signature Moalh Day Year <br /> 16.Inlamational Shipments- <br /> i; Import to U'S. Export from U.S. y Port of noWeAk <br /> 24 Transporter signature(for exports only): Dale leaving U.S.; <br /> 60 17.TmnspoderAcknowledgmenl of Recelpl of Matodals <br /> Tran oder 1 PrinledlM. 0�d Name Signature 1 Mar h Day ' Year <br /> �f' ' �..w"�" 41 "' Ell <br /> to <br /> 2d <br /> Transporter 2PrintaffypedName Signature ' _ `. Month Day Year <br /> aG r• <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 0 Quantity ❑Type ❑Residue <br /> ❑ParHaf Rejaclbn El Full Rejecffon <br /> Manifest Reference Number, <br /> 18b.A1femateFacility(or Generator) U.S.EPA ID Number <br /> Faculty's Phone; <br /> i8c,Sign (are ol'Aifemato Facility(or Generator)17— Month pay Year <br /> 10.Hazardous Waste Report Management Method Codes[.e.,codas for hazardousvrasla treatment,disposal,and recycling systems): <br /> 1. 2, 3. 4. <br /> 20.Designated FacilityOvmer ar Operator:CedifIcallon of recelpl of hazardous materials covered by lho manifest except as noted in Item 18a <br /> PdntadlTypsd Name ignaluremonth-" pay Year <br /> .j <br /> EPA Form 8700.22(Rev,;3.05) Previous editions are obsolete. p $IC4N617E)J FACILITY'S Y'S COPY <br />