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Pleaqe 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 1 of 3.Emergency Response Phone4.Manifest Tracking Number WAST ('_AC'(XV621V/1 :J 00*26182458 JJK 5.Generator's Name and Mailing Address Generarrs Sika Address(if different than mailing address) ,�04�144,1,144, Clt4n,MS('IA-1) A I"1 4 )45VTOPS 1 ''517019 'Y-)l F01i SkX,41oll ',A Generators Phone: 6.Transporter I Company Name U.S.EPA ID Number ev �, 7.TranspofleK arnp*Naniq, U.S.-EPA ID'Num bdf' 8.Designated Facility Name and Site Address U.S.EPA ID Number (Jwv*.,a1 War-te, NlwiaWvrwo1 3,S251 (Ad Roo Y,i%Vf 9,A 9 vVI i I I kotktuau t.'A 937,444 09-344i 11 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(if any)) No. Type Quantity Wt.Nol. 4S14f*041WAz,,'144id N,0 LIN_`W01,I'(i I11, W I VW 04094 I"kW With lctud - 11A)pp�t) L 3. 4. 14.Special Handling Instructions and Additional Information Pwffi��it: w)C',A_V07X0 VWi, a)171 ww Pmt*.f pill; VAeff BwAhlij..MiAleml _v 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aocuratily 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. GoneratoestOfferoes PrInted/Typed Name Signature Month Day Year _LLLL > LF&I'l La GiijaanL I 1� loc71 ,2b 1 ,D 7 _j 16.Intemational Shipments F-1 import to U.S. 0 Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U,S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year 0 Z 61341V C* ,o, Transporter Pdntedrl`�Q Name Signature Month Day Year I18.Discrepancy 18a.Discrepancy Indication Space El Quantity R Type F-1.Residue 0 Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: Uj 18c.Signature of Alternate Facility(or Generator) Month Day Year !R I Z 65CD 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 UJI 1 2. 3. 4. 20.Designated 1 1 Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. — I GENERATOR'S INITIAL COPY