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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UN I IFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MAP11.3 /*416 JJK Krhi'2 11 002182 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) U " I"' A I'li I V,I V, 60h, 'I%, Generators Phone: -1.111" 6.Transporter 1 Company Name I U.S.EPA ID Number gg qpp p2, Z 7.Tr sporter 2 Company Name U.S.EPA ID Number B.Designated FacilityiNamewand Site Address U.S.EPA ID Number t 1, W� 'hent'o-4 kos4-t4mtv, i A)n 3V"'Sl Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. lZ 1. 1 r1f fit 1161fly 1h)"w4k�Dw; S(Ahd 0 INVIfVia, OARIFIV>1r 11%1 IR, i11' OW f y LLI 01,-,k4l witb kiO ?.,10 t�iqio Z 2. Uj CD 3. 4. 14.Special Handling Instructions and Additional Information Poffik It p)i'A,V0Q1W0 we*l� Pit'-wi 1141, wixm' iiwdjvsus Mdto'fiu0 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 EPA Acknowledgment 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. GeneratorstOfferors PrintedfTyped N me Signature Month Day Year -1 16.International Shipments ❑F- El Import to U.S. 7 Export from U.S. Port of entry/exit: M Transporter signature(for exports only): Date leaving U.S.: 1Z 17.TransporterAcknowledgment of Receipt of Materials L2 Transporter I PrintedfTyped Name Signatuo Month Day Year Oast : Y 4-ffQ,4 L ZI z c Z Transporter 2 Printed/Typred Name Sig lature Month Day Year I18.Discrepancy 18a.Discrepancy Indication Space D Quantity El Type El Residue El P,rtial Rejection Flull Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number =3 0 Facility's Phone: LLI 18c.Signature of Aftermate Facility(or Generator) Month Day Year !R Z 12 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) U) LLJ 1 2. 4. 0 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 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY