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Pleape print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page I of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> if <br /> WASTE MANIFEST 'A(1XV62 J3FJ t 02108021437 JJF% <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> V.0)Radio C'fs'-�'V A;t A11' 1"",`4 AWN A 1'61 i0l"i A,. f 7S1 <br /> F'40 woflh '1 '.4,0(0 'A <br /> Generators Phone: I 1'1s 30-42 <br /> 6.Transporter I Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> . <br /> ('1hft r')j Ww"Ie <br /> iV I so4�"t <br /> koidtimaj 4 V Y,i 1�A 03 41 N V) sV 1 f <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> oil <br /> 111'-0.8 1)N V,1 /,11( 111 t)()1 ffj` 000 1 V V, <br /> M41 with 1��ad ­ "!,`0 1 410 <br /> L <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> Pt 4 wrik-P,a)1-'.AVX'V i0 At 17 1 <br /> wf-w'Pickot't Pl+witcV1 <br /> 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,l, tl <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationall and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> 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. <br /> Ggratoes/Offeprs Printed/Typed Name Signature <br /> Month Day Year <br /> !_4 <br /> 9 <br /> _j 16.Intemational Shipments <br /> P_ 1:1 Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> M Transporter signature(for exports only): Date leaving U.S.: <br /> Or 17.Transporter Acknowledgment of Receipt of Materials <br /> Uj <br /> j2 Transporter I Printedrryped Name---, Signature Month Day Year <br /> 0 <br /> IL <br /> Z Transporter 2 Printed/Typed Name <br /> 4 t Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type El Residue ElPartial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facility's Phone: <br /> i <br /> — I <br /> 0 <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> !R I <br /> Z <br /> CO) <br /> 'L.) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 <br /> LU 1 2. _T 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />