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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 Phone 4.Manifest Tracking Number - 82446 JJK WASTE MANIFEST 21 5.Generators Name and Mailing Address Generator's Site A Iress(if different than mailing address) Yx) 4-iffvk MCF-4�,N` A PN I ;11018 A� 1 15 1 `0 19 4--' 1"S I w 'A 0, if i<4o( Generators Phone: .L 121 A 1111 6.Transporter I Company Name U.S.EPA ID Number 7.Transporter Z'Cbmpany Name U.S ID Number r 4w 8.Designated Facility Name and Site Address U.S.EPA ID Number Cheink-4,11 WwJ-, Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes alit,f1wu1TfI(,tfw 1S44b!'4.aVK-i*, S44 fit I 1400"1",P(i fit (Xtl 1,111' 0001? V k"10 r tt1±1*o 2 LU . 3. 4. 14.Special Handling Instructions and Additional Information Pw,)file If o)C&MVRO VWT 101,11 Wf"at Pwfw-f 1114`: 15. GENERATOR'S10FFEROR'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 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. Generatoes/Offeror's Pdntedrryped Name Signature Month Day Year 0` ie I jQq 1.-�6 lo7 gJ-11I.Intern btions l Shipments 0 import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials TranspqAar 1 PrInled/Typed Name Signature s Month Day Year U) Transporter 2 Pdntedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity FlTyp, F-]Re,idu. D Partial Rejection El Full R.j,,U.n Manifest Reference Number: 18b.Aftemate Facility(or Generator) U.S.EPA ID Number U. Fcifily,Phone: 0 1 uj 18c.Signature of Allemate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 0 Uj 1 2. 3. 4. 1 1 1 I20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item I Ba Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY