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a3 print or type.(Form designed for use on elite(12-p'dch1 typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS f.Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.Manihat Tracking Number wAsre MANIFEST �/)L Io -7 7 /a— 7�=�- 1 a^' 6 MW 5.Generators Name and Malk A�e Generators Site Address(N ' t than maA address) Grt u C��i/C, gin. r, 6 /6 qa ,u. L3/e,411� y✓/?t, Gencralor's Phone: 1 B.Transporter 1 Com Name U.S.EPA ID Number / S 1 ?'S- 7.Tran Company Nffrne U.S.EPA ID Number B.Designated Facill Name and Site Address U.S.EPA ID Number Lt�J/ Facility's Phone: a ga, 9b.U.S.DOT Description(including Proper Shipping Na ,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(it any)) 13.Waste Codes No. Type Quantity Wt Not i �/�.-/•L;a©��._ _��-- �UJv ( 't/� �. Cyte 2. i 3. 4. 14.Special Handling Inrauchons and Additional Inforrrgation _ �1• r � 1J -7 15. GENERATOR'SIOFFEROR'S MRTIFICATION: I hereby de are that the contents of th s consignment are hdty and accurately described above by the proper stripping name,and are classiked,packaged, marked and labeledlpl and are in all respects in condilton 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 conto to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 FR 262.27(a)('d I am a large quantity generator)or(b)(01 am a small quantity generator)is true. 3eneratoesrOfferors Plintedrryped Name Signature Month Day Year IB.Inte 'onaI ipmenfst I ❑Import to U.S. ❑Export from U.S.` , Pod of entry/exit: _ Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Admowledgmant of Receipt of Materials -ransporter 1 Printed/Typed Name Signature /. Month Day Year rranspoder 'ted/Typed Name S e Month Day Year /J J 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: I8b.Alternate Facility(or Generator) U.S.EPA ID Number =acllityfs Phone: 16c.Signature of Altemate Facility or Generator) Month Day Year 19.Hazardous Waste Report Management McMM Codes(i.e.,cod for hazardous waste treatment,disposal,and recycling systems) r 1 2. 3. 4. .0.Desgnate Owner or Operator:Certification of r' ipt of tzardous materials covered by the manifest except as noted in Item 18a hinled/Typ re ` y Signatur Month D . ;orm 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR