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C7 5 C <br /> ! ©� <br /> Please prim or tyre (Form Yesryiioo for use on elite i 12-1xlctt;t}'If�s'Iter,} Form Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS I'GenefaW ID Number ` f Q C 2.Page 1 of 3 En,urgowy Response Phone 4.Manifoat Tracking Numbet <br /> WASTE MANIFEST 1D Q�:C� "I `��� �� 1-1 {I j r " FLE <br /> 7 C41Asn M a'c NVI;L4 an] 1-w34 rlCdresc `-- - eAN aWii-S•Yt fkddress(it arrratent roan IAAILino address; [] <br /> �e sara sa+rc+l Tf ..� Cog, , ci�`3"� <br /> l :I S FPA{D Num4ro' �, r <br /> I <br /> Sn}r5;,"r,•'Cf,mpmr•Name U.S EPAIDNum;,er <br /> DesIpmkil Far Name st+d&to Ar10r;.4 <br /> /�U-10 1 i u-0 ; )- I'7:oLA for- t-4Di Ito �_LL US EPA IDNumGe, <br /> Phone: 76J -6 CC) <br /> =a[tiry s <br /> �HM <br /> �DOTon(including Proper Shipping Name,Hazard Class,I tuber, 10 Containers 11 Total 12 Unit13 Waste Codes <br /> any)) No Type Quantity Wt./Vol <br /> 5�1Lib; I�)• U . S • C.� �S�+'it:, GAOmrl.�31'� (� � `, <br /> r <br /> CA L+.. I �CY.'F:i )s 1: <br /> Z 2 <br /> w <br /> 3 — <br /> i <br /> 4 --- — <br /> 14.Srec-!I 0ft tnglrugrrms and Add-!Ena1 Informator <br /> 1,C14 626 �� { <br /> I <br /> t', GENERATOR'SIOFFEROR'S CERTIFICATION; r hereby declare that the contents of lh s consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded and are is at respects•n proper condition for transport according to applicable intemational and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,1 certify That the contents of this consignment conform to lne terms of the attached EPA Acknowledgment rf Consent <br /> car*that the waste minimization statement identified in.V CFR io:?2'!ai,(I am a large guardtly Werefuf)or(b;;if I am 3 small quantity generator)rp true <br /> C?rrP1.,lur'VI ararc rdd yp�} .nit7 ,r{Ina rnr . .`, nn uer <br /> -� 1c Yr;nlls•S!�'cn1'yirlt La <br /> - 0 Import to U S Export from U S Port olon 7tn{It — <br /> rrnr,fi(!Y:¢f N •alurf{flFr exDDft.)r!F I !rS3yInG I15'ti <br /> 17 Transporter Acknow edgment of Receipt of Materials <br /> G,�p ltc-'' note dn1.^,home gnats?�� rnu, Day ear <br /> Jos <br /> ' r7rlt{�,TIB'.''h,n,?gfyyned Nrl'nP f}�rralllfN I•t"!. VRy teal <br /> Q <br /> 18 Discrepancy <br /> 18a Discrepancy Indication Space Quantity Type {--� <br /> Residue ❑Partial Rejection Il Full Rejection <br /> 18b Allernatefa;;i!, --- MarryR'S r<P'`t-ipe,+erG'ruat' <br /> (arGenermlaf) US EPA ID Number <br /> U <br /> Q <br /> �+- Fac-mv 5 rpnilre <br /> W tRr $;¢^6fMrl of Arr;m 3rr.F.1[;l its 14v rj %knur {]Ay YNdI <br /> d <br /> Z <br /> ?q reza vi,�us NasIe Rcti r n r Managemet Merhad C vifs r r- ceaes Ice na<are r_ <br /> qus wasta IroaInlenI,.bsosa1.and recycbng%ys!eM.sl <br /> I ' ]JI"T 1 2 3 :1 <br /> �P Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P',ryrut ilyr(!Nfyrn: sgt,,a ute Mpnth Day YzmI <br /> !EPA Form 8700-22(Rev 35) Previous editions are obsolete. DI°alGIVAi G[?F'ACIi!i Y TO DESTINATION STP.i E(IF REQUIRED) <br />