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Please print or type. OMB No,2050-0039 <br /> UNIFORM RAZARIDOUS 11 GeneiraloOlNumber 2 Page i of I�,_�mergency Response Phone 4.Manifest Tracking Number <br /> 1� Q FLE <br /> WASTE MANIFEST Q, 01465-a517 <br /> 5.clemator's Nam am Mlii(ng Addtm G"watXNX Site Address M diftnesit t1haii malmig wWfQ*s) <br /> -7 <br /> U-6.EPA ID Nvmbv <br /> 6.Timsoporleir I Compimy N ame <br /> r V H Ef�II 1 J I,! I+ C <br /> 7 7ranocrier 2 Cc-P'MY N-0 U.S.FPA 10 Numb& <br /> s J"nated Fav;ity ri�and Silo Address U,S.EPA tO Nwriber <br /> 1 i V.',t--,'1—'L�,`Jb'Ho fE IJ LU C'I` <br /> I-)IJ T <br /> P i 1�;E 3A <br /> �.i;:!Y5 Phone: 7P Z R 0 0 0 5 2 0 -7 <br /> ga. 91b U S DOT Description(induding Proper Shipping Name,Hazard Class,10 Number, 10,Containers 1!-Total 12.Unit 13 I,Vasle Cc&- <br /> HM and Packing Group(if any)) No Type Quantity Wt ivol <br /> 6c) J 6) <br /> M <br /> Z <br /> LLJ <br /> 3 <br /> 14 Sp�al Hard�rg InmWk?r*aod Addil-ne;0 InVFnMol P 0#E)�A)S 14 84 W.104 F5 1 2-Q 5 B I ILL E C Pk E" <br /> 15 GENERATOR'SlOfFERDIR'S CERTIFICATION:I hereby declare that the contents of this wrislint*nT are fully and accurately described above by the proper shipping name,anj are classified p2claged. <br /> marked and labeled/placarded.and are in all respects in proper condition for transport according to applicable internattonaland national governmental regulations If export shipment ard I am lhe rnniaiy <br /> Exporter,)certify that IN contents of this consignment conform to the terms oI the attached EPAAcknowlexigment of Consent, <br /> I certify that the waste minimization statement identified in 40 CFR 262 27(a)(it I am a large quanblygonwaliY)or(b)(ifl am a small is true <br /> Typed r3% V 549NIM0 W 1:t MM* <br /> 4:3AL&.14C^&4'A I <br /> 16 lwrnahcm Ssi;-Vrils Li import to U S Exporl from U S Port of entrylexit: <br /> TrardpDdo?SignMufe I(Of exports only): Date beamvg U.S <br /> IX 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpcd6f I PmWfTyW ffnn* S1gftAtL;e <br /> U) ?A)"m Da Y,,.i r <br /> m Transporter 2 PinntedfTyped N&w <br /> 18 Discrepancy <br /> Type <br /> 18a Discrepancy Indication Space El Quantity Residue Partial Rejection <br /> I Mamfosl IRAftence Number <br /> 18b.ARemate Facility(or Gef*mtoel US.EPA ID Number <br /> L) <br /> I Facwtys Phone: <br /> UJI 1 F17 S1n,-J%:4e of A1eimila Faetfi�i V G;�rvullo-rl <br /> Z <br /> 19,Hazardous Waste Report Management Method Codes(i e..codes for hazardous waste treatment.disposal.and recycling systems) <br /> LU 12 <br /> 0 1, - — 1 1 <br /> 20 Designated Facility Owner or Opemlo: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> ProNte0yrW Nw* <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />