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GSL SK SH[P# Please print or typie. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS enera or um er age, o nc� p rise WASTE MANIFEST J, 5.CWere%ft Name and Melling Address C*rieralors Site Address(d differeiri than mailing address) 8010 E TRACY (,A ZAC5304-0000 Generators Phone 07fj 15 1 7.Transporter 2 Company Name U-S,EPAID Number B.Des[griated Facility Name and Site Address C;(.[-PN HARBORS ARAGONITE, L.U.' U.S.EPA ID Number 116130 NORTH %,)TIJP3 ROM 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contaii ers 11.Total 12.Unit 13-Waste Codes HM and Packing Group(if any)) No. TyM Quantity Wt./Vol. AIXT LU LU F .3 WASTE CORMUVE LIQUID ASSC 1 141 IDE AND �10TASSIUM HYDRRIli-11 a, F's 11 t 14-Special HanAng Instructions and Addittorial Inlormation 'I'S 1 11)C-0 8457749? 011220 18 C.S 6 1 15 GENERATOR'SIOFFEROR'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 EPA Acknowledgment 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. Generator's/Offeror's Printed/Typed Name Month Day Year 16.International Shipments Import to U,S. Export from U.'s. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Recdipt of Materials Transporter 1 Printed/Typed,Name Signature Month Day Year Z Transporter.2-Printed/Typed Name Signattfre Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space 11 Quantity El Type Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number Zi ;� Facility's Phone. iu,j 18c.Signature of Alternate Facility(or Generator) Month Day Year 19,Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 q��.12-17) Previous editions are obsplete. GENERATOR'S INITIAL COPY 71 ' ------ -------- ----- '----- --