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Please print or type.(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.2050-00 UNIFORM HAZARDOUS umber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTEMANIFEST C' `1 00V y 1 7�3 1 6 ,510 -+b3- y3b`l 000257467 MW 5.Generator's Name and MailingAddress Generators Site Address(if different Tran mailing address) gLVSAL MA-VC IAL. M IA4ER(AI•� LLC. 161-10, !�I i3 r�D ASC 164tl, N• u A-y t sroc ,int, - �1,s?-�> S-V-C) TC) tJj � '+ y Sic% Generator's Phone: b S - 6.Trans er 1 Comps y Name U.S.EPA ID Number C)Q 7.Trans orter 2 Company Name U.S-VA ID W-umber 8.Designated Facility Name and Site Add s U.S.EPA ID Number G �f� s.yrxi V4 L.v9CA-�1 I ^(03 6 0 AD 192) ga. 9b.U.S.DOT Description(IncludemglProper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Trial 12.Unit 13.Waste Codes HM and Pecking Group(if any)) P1o. Type Quantity Wt.Nol. 1. lea - Z 2. W 3. 4 - -- 14.Speciaal�ll}Handling Instructions and Ad nal Information Int C �1fSa-ISE q 15. GENERATOR'S10FFEROR'S CERTI (CATION: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 lebeledfpfacarded,and ain all respells in proper oondi6on for transport according to applicable international and national governmental regulations.N export shipment and I am the Primary Exporter,I certify that the contents of ts consignment conform to the terms of the attached EPAAckrowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(i I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator'sl0lfernr•s PdntedlTyped Name Signa , 7 Month Day Year 10- r i�J �� 4 2�w -+ 16.InIeKafidnal Shipments ❑ pod to U.S. ❑Export horn .S. Port of entry/exit __ Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAdrnowledgrnent of Receipt of Materials tr Trarspo 1 FXntedIrryped Name Signature nth Day Year Q Transporff2Prini fiypiealvame Sgnat Day Ye r r 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J _ - v LL Facility's Phone: W 18c.Signature ofABemate Facility(or Gan tor) Month Day Year Q Z N19.Hazardous Waste Report ManagemengMethod Codes(.e.,codes for hazardous waste treatrnenl,disposal,and recycling systems) 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator,Certiflcation of receipt of hazardous materials c'vered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOIJIFIFD)