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Please print or type. (Form designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Gene atgr ID Number 2 Page 1 of 3 Emergency Response Phone 4 Manifest Tracking Number 'JVASTE MANIFEST r - " - - T ¢ h h FLE . . , .� nay SGene2tors Name and Mal ngAddress Generator's Site Address (if diderent than mailing_ address) Generators Phonei 7 Transporter 1 Company Name% U.S. EPA ID Number 7 7ransporter2 Company Name U S,EPA ID Number 8 Designated F Ity Name and Site Address Y U.S. EPA ID Number Facility's Phone: ga 9b. U.S DOT Descil (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit HM and Packing Group (If any)) 13. Waste Code No. Type Quantity NUvol. z 2. Did 3. 4 74. Sp clal Handling Instructors and Additional InformationQ _T — 3 ea - c✓ w -.? o ' 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 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 labeled/placarded, and are In all respects In proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identfled In 40 CFR 26227(a) (if I am a large quanfiry generator) or (b) (If lam a small quan9ty generator) is true. ( Generamfslgfferors Pnntedfiyped Name Ignaure Month Day Ye37r o International Shipments � - kz n cay z ❑ Import to U.S, ❑ Export from U S Port of entrylexit: Transporter signature (far export onl Date leaving U.S.: sti 17. Transporter Acknowledgment of Receipt of MaterialsLJ > 0� Tiahsporter1 PrintedlTypetll me Ignature ^-^— Mont a � y Year do a � Transporter2 Printed/ Name Signature Month Day, Year cci 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ 1 ❑ Full Rejection El Residue Partial Rejection Manifest Reference Number: 7p7 18b. Alternate Facility (or Generator) U.S. EPA ID Number IU r= Facrli 's Phone: „aJ 78c. Signature ofAlternate Facility (or Generator) Month Day Year Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal,and recycling systems) - - do 1 . 2. 3. 4. 20 Designated Facility Owner or Oprator Certfcaton of receipt of hazardous materials covered by the manifest except as notedin Item 18a Priarvill.TypIad Name Signature i - Month Day Year r EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY 70 GENERATOR