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<br />UNIFORM HAZARDOUS I. Generator ID Number 2. Page 1 of 3. Emergency Response Phone
<br />4. manihst Trackf Humber
<br />WASTE MANIFEST (t? ��`- n.'f �3 �} f .,�-,..'� ,':
<br />00872425 FLE
<br />5. Gerieralor's Name and Mailing Address Generators Site Address (if different than mailing address)
<br />DLA. lar- F't—,ft roI s lDoi 1P. [ ..z , .• aI;rIr+�`:.'
<br />1 , '751'J x'17 [7: `rQ�t=G'IITE n!1� r 91'1 C 1'fi: ;;`ITL Win
<br />Generator's Phone: ilr-t{';,i ill, rA%��Ji. ;�^�;'' I i.rl�i:[�ir its
<br />6, Transporter 1 Company Name U.S. EPA ID Number
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<br />7. Transporter 2 Company Name U.S. EPA ID Number
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<br />S. Designated Facility Nameufd SiteAddresstl2llC`z-;41 kn'!il'Oil.uart' ;!. ,',I) LLL U.S. EPA 10 Number
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<br />9b. U.S DOT Description (including Proper Shipping Name, Hazard Class, ID Number,
<br />10. Containers
<br />11. Total
<br />12. Unit
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<br />and Packing Group (if any)) i
<br />Quantity
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<br />13. Waste Codes
<br />No.
<br />Type
<br />liquid, n. o.
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<br />14. Special Handling Instructions and Additional Information 1 . 11 E3:i { C n ! f; i. er i o t i i. C} L o D U e p ac k } 2. i 1 r�9 ! b { F 1. _^.;] 9 c1b 1. p
<br />_ if�L: S� _t a-t�p�rH) _ • 'r IUT5AI IA41'G 0 Liquid !da -i e t,'F limy) -
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<br />15. GENERATOR'SIOFFEROR'S CERT1FiCATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged,
<br />marked and Iabeledlplacarded, 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
<br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA AckomAedgmenl of Consent.
<br />I certify that the waste minimization statemerg identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if 1 am a small quantity generjtor) is true
<br />eneratorrars Printedfryped Name 6ignaturej morim Uay Year 71111
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<br />16. Interhational Shipments
<br />Elimportto U.S. ❑ Export from U.S. Port of entrylexit:
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<br />Transporter signature (for exports only): Date teavino U.S.:
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<br />17- Transporter Acknowledgment of Receipt of Materials l� .•--�
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<br />Transporter 1 PrintWyped Name y Month Day
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<br />Transpgrter 2 Printadrlyped Name / igna^ure \ 1 ti Month ear
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<br />18. Discrepancy
<br />18a. Discrepancy Indication Space
<br />Quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection
<br />Manifest Reference Number:
<br />18b. Alternate Facility (or Generator) U.S. EPA 1D Number
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<br />Facility's Phone:
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<br />18c. Signature of Allemate Facility (or Generator) Month Day Year
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<br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />1.
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<br />1-1 � 2.
<br />44 I3.
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<br />20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covergby the manifest except as noted in Item/8a
<br />Print �y dN�ame �� / Signature � y Month Year
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<br />EPA
<br />Fomt8700=22 (Rev. 3.051 Previous editions are obsolete.
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