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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 1.Generator ID Number 2.Page I of 3.Emergency ResponseMariftst Tracking Number WASTE MANIFEST ICACU"' ) (12O13" - 1 1 77 7. 002182453 JJK 5.Generators Name and Mailing ddress Geppp is Atm ss(if different than mailing address) All" 174,147018,& FIN Generators Phone:f.,. 6.Transporter 1 Co pa Nam U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Clwmic,411 Wash-kllm4�-Vwwnl '35251 "St-Aw"kwd 4 N 4").46 11 Facility's Phone: 9a. 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(ff any)) No. Type Quantity Wt.Nol. 1- RQ' '�Ohd 0 N 04S 11410 7,11(1111. 00 1 I'M IV W)I Y, N o�with kwj 220 Ilf"Ifl) 2. Uj 3. 4. 14.Special Handling Instructions and Additional Information flyiafik-11,a.)CKUK1280 1"W-1 004 Wear Pfc4XIT,14111 :at Mtlleftol#,1"U4,06iti, 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,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. 7rators/ prors Printed/Typed Nae Signeture Month Day Year M % F 6L 6 1 )7 -J16.Intemational Shipments F- M import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: Uj 17.TransporterAcknowledgment of Receipt of Materials r 1 Printedi"a a Signature Month Day Year 0 m CL Z MTransporter 2"Printed rl"yped Name SignatureV Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number LL. Facility's Phone: a I tu 18c.Signature of Aftemate Facility(or Generator) Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) o UJ 1. -T.-- 1 2. 4.1 1 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedfryped Name Signature Month I DaytYear] EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY