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print or type.(Form designed for use on elite)(i 2-piiGh)typewriter.) Form Approved.OMB No.2050-M9 <br /> S 1.GeaemW 0 Z I of 3.Erffgency Response Phone 14.Mv <br /> P/Oe/hNNFORM HAZARDOUS ik'st Tracking Number <br /> WASTE <br /> _7 D <br /> MANIFEST G B F <br /> Ste Address;d different than rraftg aoftss) <br /> frl f 'q <br /> A 11 / <br /> I P-j <br /> Generafor's Phone <br /> 6.Trarpovier I Gorriparry Name U.S.EFA V Number <br /> 7 <br /> 4� <br /> 7.T `2 canp,",ha. U7S.lEPA ID.Nirtw <br /> I Designated Fa"�&w and Site Address U.S.EPA H)Number <br /> 10 <br /> /Y 4e 0 0&0 S <br /> Fawn <br /> War, <br /> 90- qb-US.DOT BGq=0wfn*dNProper Name,HMW pass,ID Number 16-contalners il-Tow 12.Unit 13.Waste Codes. <br /> lim awpadkvQftv(ifaw))-- No. Type QLonbty <br /> 4,— <br /> Q Fr <br /> f--!;,,, K C 4-11IA5 44 <br /> 0 <br /> r <br /> 2- <br /> 4. <br /> 14.SpeaaHRanckig lnstwc5Dn&and Ad 'aoi kdorm <br /> 'Ord <br /> V;_ <br /> 15. GENEPATORIS]OFFERM'S CERTIFICATION:1h�eby declare that the contents of this consignment am fuPy and aaarately descnled abo�e by the proper shipping name.ain are dass&d.P?zkaged, <br /> marked aidlaboodiplacadkA,and aminall respedsin proper omcRion for hrw.�od accon*V to appkable international"national govefrarA41al regt�aticas.If export stpmentarra lamftPrmwy <br /> Exporter.I cefffy that the to-L-ints a,this wnsjj conform to the ferns of the atti-dwd EPA.Arim%ied -,of CxcserL <br /> I certify that the waste mininizaWn stalernent identified in 40 CFR 20 9 ka)(I I am a large quantity generator!or(h)(if I am a groP quality g--wa*is true. <br /> Gen rql)&,pt-,Pinted(TyWd N.I.0 swat- Month Day --Yw <br /> =j 16 Intermlialal ShipnwLs <br /> Ll <br /> Zichl)(311 10 U S. Export from U.S. Part of U!ry"evIc <br /> Twspwf-r sinature(for expor's only): Date leaving U.S.: <br /> Xt 17,TransowerAduig.-&-dgmentof,Rem?!of Maler-* <br /> Ll <br /> Transporter 1 PrmtedfTypedNme Signature Morith Day Year <br /> ag <br /> Za j <br /> Transporter 2 P6064,Tjped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Irdcator,Space D ardy EJTYP- Residue tJ P.-.,aj RA R6,-'.,- <br /> Mar&st Reference NLm%l)e,- <br /> 18b.Ailernale Famly(or Ckmeratx) U.S.EPA 10 Number <br /> LL Facility's Pbw-e-, <br /> 0 <br /> uj 18r.Signature of,Allernale FacVy(cr GenefaW <br /> TorDay Year, <br /> CD <br /> 19.Hazardous Waste Report Management Method GDdes(i.e..codes for hazard=waste MaDwt disposal.and W�60V systems) <br /> 1. T 4. <br /> 20.DeMpaied Fxitfty OvM, of OWalor W-GaW Of j"pt ofWwjommaWi3Is wined WIM manft exe%as noW irimn)183 'Jr <br /> Print��d NanaSkjnaLm f i Jmmm Day Year <br /> � <br /> I t <br /> EPA Form 8700-22(Rey.H5) Previcits edihor*are ob$oWe. <br />