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i <br />,a,u..:,• s , iii,• <br />EPA Form 8700.22 (Rev. 12-17) Previous editions are <br />Address <br />Fouda11atir*GtorMimtt Malksal Plan Gtdta C.,, -i k ' ., '.i :.• • i- a...W"ItOdfthM.+ a . '.: 2 <br />h,I.. <br />i—Transpoder. f: f <br />4uhAkw <br />CALOW43M <br />7, Tt der 2 Cam nyri mi <br />O.DesillnoladFacili Name and Silo Address <br />US, EPA 1 Number <br />V, OW Goldlons LLG <br />.ti <br />. I <br />FacilitftPhono „I- <br />and Paching Group (deny))_ <br />:..ll-landlinglastru andAdditionatinformallon /..i. M i <br />., .. <br />CIA <br />Import to U.S. nExportfrom"UMS, Port of entrylexit. <br />Data leaving <br />Disc(epar4 Indication Space Quantity El Type Res(due <br />Paffial Rejection Fun Rejection <br />Referencel8a, <br />Manlfest <br />18bt Alternate Facility (o(Genoratot) <br />U.S.EPAIDNumber <br />Facility's Phone: <br />i <br />, <br />19. Hazardous Waste Report Management Method Codes (i,e,, codes for hazardous waste treatment, disposal,.: <br />iecycling systems)20, <br />Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as acted In Item 18a <br />Day <br />obsolete, I KAIVSYUK I tK (iUYT <br />