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Please 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 Phone4.Manifest Tra#INcking Number WASTE MANIFEST r `tft � "p 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) VO P'Idc4 t: F t't A , *sa'#,'31 -I'N l 1)1 It11h t 1'A-01Q , t =:a I arf1 VV,tr+)1 j,4 a`tI?r' "I Generator's Phone: ° r 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Nameg U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 1� 31 Cd a'.loyho-' 7fLg.;9a�.i e''A410K�d6r,'iA 17. r((( saxltt`ifi <'A {:j,a19 5:S1*NK6-Q11j Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(d any)) No. Type Quantity Wt.Nol. 13.Waste Codes x 1. i 4sssa1` ati�)( Iaaalr�t� �tstyt<stt� >t ;��(i% est j N't A _,9 I t f} j"f o jjj, 1t9j rf1' (if,t1 81 (&A with 4o,1 ,20 j-,gxis) L CS 3. 4. 14.Special Handling instructions and Additional Information Pmfiw,fl,41 ;A001"Ws) °,. . gi p j At:= r• € ( Fes �cbl j�I' . 'fx:�ts jfbjaltjs tIfaf a1j 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 classed,packaged, t marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationai 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 EPAAcknowledgment 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. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 1 f $..e. -AL J 16.international Shipments I- El import to U.S. EJ Export from U.S. Port of entry/exit: ® Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped�Name Signature Month Day Year H r . , ZZ Transporter 2 Pdntedfryped Name Signature Month Day liar a t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quanti ty ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J cs LL Facility's Phone: W 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) ® 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(fyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL