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Plea,5e 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 WASTE MANIFEST ilt. tU A I 0 0 42'18 2 4 3 1 JJ 5.Generators Name and Mailing.Address Generators Site Address(if different than mailing address) iiubo V� V Akily,�*kJ!,�A i, '1,,t I��M!,1�1 1-4 '0 P N 1 T I'i 18 1 11-099 0�,. I ,A,K�IIA(wl- 'A Generators Phone: 6.Transporter 1pany Name U.S.EPA ID Number �7 14 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number WoFlv 1, 1 Old�1,1-f lo V A=IV 0,`h 16i I K04-amit�`ik,,('A 14 k"'1" %41)-1 ` Facility's Phone: 9a. 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. 1. 11t4r F"I jftwyl Till pf"T Ito o1`- K() "(),#it,}, �',� 04,11 TTV (9K1 R (&A With'€gad, T."10 u�llo L 3. 4. 14.Special Handling Instructions and Additional Information it)('AAANt'-W 0171 wt-81 11wilt"'I 141f;whi,�v 1141041mr, 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 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. Generators/Ferors Printed/Typed Nam,, Signature I Month Day Year A -j 16.International Shipments P- El Import to U.S. D Export from U.S. Port of entry/exit: 9 Transporter signature(for exports only): Date leaving U.S.: Be 17.Transporter Acknowledgment of Receipt of Materials U Transpo r 1 Printedfryped Name r� Signature, a Month Day Year 0 CL Z Transporter 2 Printed/TypediName Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space Quantity Type El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number F.cilitys Phone: C3 LU 18c.Signature of Alternate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Uj 1 2. 0 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a [7 Name I Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY