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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 WASTE MANIFEST _V II JJK 002-IL402469 5.Generator's Name and Mailin Address GTeraV.r,s§jtjress(if different than mailing address) 7 VO kailto Slwch 4(4r,NiS A[+J I U-4-0 Generators Phone: KI 4I`-3V W 6.Transporter I Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number Ow,ft"knal wit'gle 15251 01d,skyluir 14qty d I Ktittkmait Facility's Phone: 9a. 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(K any)) No. Type Quantity Wt.Nol. 1 N,0 1),OFNV'77,VG 1117, 001 1�1' K0 18 j:1,',Sit with kwf , 22-0 so Z 2. LU 3. 4. 14.Special Handling Instructions and Additional Information FR(f P,41-0 wom,Vrc 'P11F, 11c111#,ff wititky Makmtj 15. GENERATOR'SIOFFEROWS 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 lam a large quantity generator)or(b)(if I am a small quantity generator)is true. rGe;_gal,es/Off9rocs Printed/Typed Nam Signature Month Day Year ri 16.Intemational Shipments El import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: UA 17.Transporter Acknowledgment of Receipt of Materials EE Transporter I Printed/Typed Name Signature Month Day Year 0 Itw ti A Transporter 2 Printed/Typed Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number 0, litysilhone:i 59 18c.Signature bf Afternate Facility(or Generator) Month Day Year 119,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 1 2. 1 3. 4, Lftte20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Typ d[Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY