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.. Q Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050_003 UNIFORM HAZARDOUS 1.Generator ID Number =0(fl . Response Phone 4.Manifest Tracking Number 3 FLE WASTE MANIFEST 01 n 7 8 8 4 5.Generator's Name and Mailing Address Generator's ite A'dress if different than mailing address) {office Max #6;298 Office Max#6298 2099579771 4733 Quail Lakes Chive 4733 Quail Lakes Drive Generator's Phone: 5a07 r-4fnn_ M__ 14C.P07St 6.Transporter 1 Company Name U.S.E A ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt. LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova. GA 95742 Facility's Phone: , 916,351121191912 1 roDs 884183 01 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. a 1,#ion RCRA hazardous waste, solid (Cgs STATE 1 CF wool P 33 RE LATER. IDS), 2. L ca 3. 4. r 14.Special Handling Instructions and Additional Information i. 102343(GA State Regulated Organic Containing Solids) 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 intemational 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 identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) Month ay Year e' eros noted yped m 1 16:international Shipments E Import to U.S. ❑Export from U.S. Port of entry/exit Transporter s' nature for exports only): Date leaving U.S.: It 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature ont ay Year I cc Johnny Harner Month ay Year z Transporter 2 Printed/TypedName igna a F- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number ..r V Q u- Facility's Phone: Ck W 18c.Signature of Alternate 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) } 90 4.2. 3. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name 0 Signature Month Day Year IN 1171 f EPA Form 8700- ev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATIO[d STATE{IF REQUIRED)