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Pleqe 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 -'A("(102f i2l 07 1 4 1 0021.8"452 JJK- 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) AI+J' I WA AM 8&� I'VJ-/Of"&--" 1'181 VX)Vwfu�Shwt Cifdf�IMS('14,-1) 1 14-,, "I I--"ftWc,VI1i 'IN 7,SIO? N J*,f 6 Generators Phone: ,1 k,'g 1 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 C-6any lRik U.S.5PA I Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Cbr,"*)A wflot- 3,01 Ob-1 S1, 1we jli�ql �Xf fKXh*-d I"i Facility's Phone: ga. 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(ff any)) No. Type Quantity Wt.Nol. AXi?sstttftl &4id fal I 0 (18"11 With k-Ad �'20 KA11) L 3. 4. 14.Special Handling Instructions and Additional Information Pictfil-c k a-)CA-'XX')M* F'RO 0171 W"t ft"en, 1114,"whelf 11tw41111w,mou-44-t 15. GENERATOR'SlOFFEROR'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/Offeroes PrintedfTyped Nme Signature I [ , Month Day Year 'Bill (T ZZ i-T 0 C,ri�l- L -omm I OIL,' —j 16.International Shipments 1— 11 Import to U.S. E:]Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: L= 17.TransporterAcknowledgment of Receipt of Materials Transporter I PrIntedl/Typed Name Signature Month Day --Year 0 CL A C0 4-a� Transporter 2 Pdhtedrryp.d Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space F] Quantity Type 1:1 Residue El Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number < M Facility's Phone: C3 1 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) 0Uj 1. -- 1 2. -T. 4. Fnnte-Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a yp ds/T ad Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY