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JUI Y 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 i of 0. Emergency Response Phone 4. Manifest Tracking Number E uI WASE MANIFEST UAL 0 0 0 3 Z d 7 Y .Ni .9 (bCh)) r42 i1 iGdUtb 018237 "799 beer 7 J J K t . 5. Generator's Name and Mailing Address , " nGenerators SibrAddress (if different than mailing address) In Ir PAUL Wk_ NGO , GOOD GAR GOIAWANY - Ot,'9t! All IUUIa'stll: IfGIRGI ( - -, 3TOOKI ON ( A" r3r1,„> E 2 Generators Phone: (4`�, z p , A4ki�J' ;`r v ?r.! i 1r 6. Transporter,ilCompany Name I ' s )InI i ; i c U.9. EPAID Number A,SBURYWVjRw4dr hNildl. SFN1 jt f..� PAP, 01� U R 7 TO 3 @ 7. Transporter 2 Company Name _ - U S. PA ID - � N umber 8, Designated Facility Name and Site Address U.S EPA ID Number U ' LUOLO Y VEMOfd €Idf, 631 ,43 wtYU ( ti 1504(1 AVENUE fi (nLL( 90068 AI) 09Y01O () ; : > Facigl es Phone " 1(3t3)r fY3hJU15) ' ` g0, Sb U.S. DOT Description (Inclang Proper Shipping Name Ha;ardLlass ID Number, iji: 10 Containers 71. '(olal )2It,Upif r 13. Waste Codes HM .and Packing Group (if any)) ' No. Type Quantity WLNoI. In 1, Pdr�ry-tt::ftri NA7J45d(J{;LEii t'dA. 'i`fi JIJi11J �(kBbIAKW VAflfileg9AVJN0S) 0 f 15" 'ditl 0 fvi� W 2 .� 3. It 4 14. Special Handling Instructions and Additional information ..? ` J 7. ,. FIVILH001GYGON](Ai :'I otowlRM 1,800,4" 24-913fX) WOF.3rliYWUNAt GL. h�(:c3C�in NAtLNG# JN3J : -9:,71 "- VROFILE # Ob:.1 99 , AI t4iS'. ti7 [�I2NiGs"sSiAViWfa; �` P6(10-0004928 ) � AWII3(,)tRlk7EF LdSOi`d L N4)TLt.IIV: F41t1t6'MIFi`! f In 15. GENERATOWSIOFFEROR'S CERTIFICATION:,I hereby declare that the contents of this consignment are fully and accurately described above byffie proper shipping name,and are classified, packaged, marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable inlernationat,and national governmental regulations.If export shipment ands am the Primary- Exporter; I cedify That the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. - 1codify that the waste minimization statement identified in 40 CFR 262.27(a) (if l am a large quanlily generator) oi (b)(ifI am a small quantity, generator) Is true. - Generators/Offerors PnntedRyped,Name Signature z I 1 Montt , Day- Year , nr Ii j � `n � � k-�v _ ,1 ( f0, In j 16. International Shipments - r ❑ Import to U.S. ; ' ❑ Exporftrom U,S, - ' Pod of entry/exit: Transporter signature (for exports only): Date leaving U.S.: - w 17. TranspoderAcknowledgmenl of Receipt of Materials Transporter l Printed/Typed NameM09ih pay Year EL / Transporler 2 Prinledrryped Name Signature Month Day Year i-- 18. Discrepancy r 18a. Discrepancy Indication Space ❑ Quantity ❑ Typoj El Full Rejection ❑ Residue Partial Rejection Manifest Reference Number: . - J 18b. Atternate Facility (or Generator) U.S. EPA ID Number _ .V - LL Facllily's Phone: - - w 18c. Signature of Alternate Facility (or Generator) - - Month Day . . Year `a N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment disposal, antlfecycling systems) 20. Designated Facility Owner or Operato Certification of receipt of hazardous materials covered by the manifest except as noted in gem l8a f [ Printed/Typed Name Signature �3 / t- -- I Month Day Year _.-. IT aW �60AOe It EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. _ TRANSPORTER'S COi I.