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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1 r ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number UNIFORM HAZARDOUS 1.Generato FEST M'(XY,!6'�I l, WASTE MANIFEST - I I 1 002.1-82423 JJK- 5.Generators Name and Mallini Address Gene ress(If different than mailing address) ,Itufi�� MY9 Pwfil,P Sfn�v, fvl,� TA,-;11 Generator's Phone: 'M 6.Transporter 1 Company Name U.S EPA ID Number YM 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number hcv4,J(,A wa,.Ak-Matfkqy�vviu I 03,{ fA',01!1c rV i 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./Vol. 1. W) I X, y 2. LU CD 3. 4. 14.Special Handling Instructions and Additional Information 15. GENERATOR'S/OFFEROR'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 intemational 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. ffener�ators/Offeroes Printedfryped Name r Signatur t Month Day Year k)7 t .-j 116.International Shipments ❑Import to U.S. E]Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials 62 TransporterMm ame S,%ture y Month Da Year 0 Z Transporter 2 Printed/Typed Name Sign` re Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: wZ - 1 Month Day Year 18c.Signature of Alternate Facility(or Generator) 7 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ul TC3 1. 1 2. 3. 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