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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) --p7—ag—e-17TI3.Emergency Response Phone Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 4.Manifest Tracking Number WASTE MANIFEST - I 1 1002182447 JJ 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) KA- lits Slfwl ("uck GL,CPA Ji APH I->il 10M ek, I ISI y0l!)b tk', 4'7'1 A ',14"Nyo Generator's Phone: IS 17-4 1 S' 6.T ob ,,p U.S.EPA)D,Nur,er '�oder I Company Name < 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number "'boffit"A Wo Ig., 3,951 "-4d =*yhvw'Rood i I Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.1V0I. 1 Ift, NO S ,9,ON't077,K-4 III, W1 Uff 0(ff"I I 44 cA1 With lead 1:'11J41) 2. UJ 3. 4. 14.Special Handling Instructions and Additional Information holile 4 wo("A'001%) It I.a)I't I -7 Wa l teal i,Ppli,Mwas flarldlim ktili"'(431 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. G t estoff )r's Printed/Typed Name Signature 7RO Month Day Year 7r K A 6 -J 16.Intemational Shipments Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials ortr PrintedIT Name Signature Month, Day Year_ — 0 CL /V Z Transporter 2 PrIntedrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity Type ❑Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Yearth Day -7n1 1 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UJ 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/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY