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Jf iii_ l:�1f. i'.1Lij '' s":i-�z t, f i. V 1<60 /03 ) 3 Please print or e. Form desi ned for use on elite 12 itch 0 0 b 2 6 5 7 7 0 S K S P type.( g ( p }typewrites} Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator Ip Number 2.Pae 3 of 3.Emergency Response Phone 4.ManUt Tracking Number WASTE MANIFESTCP L 6 2 85770 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ".`i.t.TT�, ; i f Generator's Phone: ?.;r.="-7¢ j- =1f 6.Transporter 1 CmName Ag,, 'i Com" a,_-N U.S.EPA ID Number f POCZPt03120 7 Transporter 2 Company Name U.S.EPA ID Number i. -..r .NVT Rf7NK-'. NTq- L tai.. INC.'., �-5 B.Designated Facility Name and Site Address t I t.tt tr` F ` }.'F4. ha U.S.EPA ID Number Facility's Phone: N}' 0 f.),* .7 -i t ga. 9b.U.S.DOT Description{including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)} 13.Waste Codes No. Type Quantity Wt.Nol. a 1' ' t�tt;aCa i1wslLiL: 1�1c,fr tr,11�7;c, - r . z 2. W k.7 IER 3. 4. 14.*dal Handling Instructions and Additional Information f Y s i 1-60 fSK T!--'� 0(t Oq oiol 1, y.?I, 5 f.,y_. s A€q F a C'I i. : 7 _Ci[ C1 C' 3 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the Contents of this consignment are fully and accurately described abov by the prop r ipping name,and are classified,packaged, marked and labeled/placarded,and are in ali respects in proper condition for transport according to applicable international and national g er ental r tions.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 nsent. I certify that the waste minimization statement identified in 40 GFR 262.27(a)(if I am a large quantity generator)or I am a s all q tor)is true. Generator's/Offeror's PrintedlTyped Name Signature onth Day Year vI X I.z J 16.International Shipments Z ❑Impart to U.S. ❑Export from U.S. f Po f entrylexit: Transporter signature(for exports only): Date leaving U.S.: X 17.Transporter Acknowledgment of Receipt of Materials Tra r 1 Printedi d Name Signature Month Day Year a Q Transpo Pri adi NameSi nature g Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type 1:1 Residue ❑Partial Rejection ❑Full Rejection 18b.AlternateFacility(or Generator) Manifest Reference Number: U.S.EPA ID Number J U L Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a CD z 19.Hazardous Waste Report Management Method Codes{i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ p 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 Prince ed Name Si Month DayYea EPA Form 700.22(Rev. -45) Previous editions are obsolete. SIG�ATD C11 ITY TO DESTINATION STATE(IF REQUIRED)