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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST F 4j Vt2417 1 X!1 1 002182412 JJK 5.Generators Name and Mailing A dre ss Generators Site Address(if different than mailing address) k w.jSlvwk Ahac Ii `0f-,y V,w*,4�83 lak-k 4'AI cwict WS, IA'3',! A VV 17 1'14)18 40- 1 's# ?0 1 'A 'AVX60 Generators Phone: -Y 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.ERR IDIqu-mber 8.Designated Facility Name andwSite Address U.S.EPA ID Number Ct"11 firi(m) tvrif, i W1190-161 I il*y,(,'.A 6-41,W Y Ax'b- i t.1 Facility's Phone: ga. 9b.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.Nol. I. Oil 0 TOIL y ("S.4f With Ic-,ttJ 7-A)uxo Uj 3. 4. 14.Special Handling Instructions and Additional Information wf:�av 15. GENERATOR'SlOFFEROR'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 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 EPAAcknow4edgment 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. Generatoes/OfferDrs Printed[Typed Name Signature t Month Day Year 0 oT F -1 16.International Shipments ElImport to U.S. E1Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17.TransporterAckn L"--X ant of Receipt of Materials Transporter I PrintediTyped7ame Signature Month Day Year 0 CL ,Alo ca -7- 0� Z Transporter 2 PrintedlTyped-Name SignatureMonth' Day Year I18.Discrepancy 18a.Discrepancy Indication Space El Quantity El TypeEl Residue E]ParU,l Rejection D Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: Uj 18c.Signature of Alternate Facility(or Generator) Month Day Year !R Z 0 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 Uj 1 2. 3. 4. 1 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY