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Please print or type- Form Appfoved.OMB No.2050-0039 —T-2P a— UNIFORM HAZARDOUSID Number ge,1 of 3.,E� jsePIhqqe. 4.Manifest Tracking Number 1.Generator Re�spoT Y WASTE MANIFEST SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) _5 Generator's Phone: B. U.S.EPA ID Number IT �CIttlll SYSTEMS I W 7-Transporter 2 Compan Name U.S.EPA ID Number HL1W1Bi017`-- SVC W. 8.Designated Facility Name and Site Address f-- )0 U.S.EPA ID Number P., �.J. Facilill es Phone: 435-884 LIT 8 4029 UTD98 15 52 17 7 ga. 91b.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.[VOII 1. HA7ARDWS WASITF, I P 134 o I.I flUIDS, (IIETERWMTS) *tA- 2 LU 3, 4. 14.Special Handling Instructions and Additional Information a457!49? 1 T..P 6t�1 '86 t J c t 0 17 15. GEN ERATOR'S/OFFERO R'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/Oleror's Printed/Typed Name r tSignature Month Day Year _j 16.International Shipments fi El import to U.S. ❑Export from U.S, Port of entry/exit: Transporter signature(for exports only): Date leaving U.S,: W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter I PrinlsdlTrped Name Signature Month Day Year . 0 1 A 4r, <Cn ;z TSignature Transporter 2 Prifited/Typed Name 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 LL Facility's Phone: Lij 18c.Signature of Alternate Facility(or Generator) Po—nth Day Year 19,Hazardous Waste Report Management Method Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) ,Iqnated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a W Name S"ka Morilh Day Year (Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY