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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number s WASTE MANIFEST006182409 JJK_ 5.Generators Name and MailinAddress Generator's Site Address(if different than mailing address) �i;arts '�tgg�e_$• }} 5 # qq tt abacs�f:gg yy q gg & Generator's Phone: a t ,1(`: 6.Trans itirtertCom ny Name U.S EPA ID Number 3� 7.Transpoft6r 2 Company Name �, U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number (Ad �`�rdP`��1t RYbd?fkk�t,'$4B°'tEi' �S.t`;�1�?''bSl..�t t4� ; .?d f�.�.x{?. ➢�$# '4�'"hp.,4i?t j Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. 1' tit't I"01`14W� f3f•T0H V 1l xul1rtAt''s rytt)te t ftt 4-, , Rg flIx Z 2. L C9 3. 4. 14.Special Handlingg Instructions and Additional Information / ( 0ikd?I %j 4 A*>A$t`3�?.9 '��tt �gtk�l�� )tl').��°� �t l �tfa`�)tfaf=��~�1r•at,a� a. 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 classed,packaged, marked and labeled/placarded,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 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 generator)or(b)(if I am a small quantity generator)is true. [Gener-ator's/Offiiiror's Printed(Typed N me Signatu r < Month Day Year r - 1 16.International Shipments z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leg U.S. , W 17.Transporter Acknowledgment of Receipt of Materials Tran ortPrinted/Typed N4We Signature . q, t Mgr y r at i l + r `° Z Transporter 2 Printed/Typed Name Signature Month Day Year H € 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J cV Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. i 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year I I i EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S IITI L COPY +) I