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Please pririt or type.(Form designed for Use oh elite(12• itch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trac482- <br /> g Number <br /> WASTE MANIFEST tr 4, (. r1 f; fi t v ; . (' i ', : (i�++ }i 1 s: ;.r 013 j 94 JJ K <br /> 5.Generator's Name and Melling Address Generators Site Address(If different than mailing address) <br /> Cool=s Coili4ion of Traci :cors Ccilisicx,ofTrav, <br /> i1;4 R?ai^St A v t o PIv- Err 1`•4 <br /> TCyF _•:. GF=, <br /> Generators Phone: 4 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> t.�Cl'dlct7ril'flt�rl[3t L.Of!tatl:.�, iflf= !-. ;�: f7 f'et1 � 1 �•; <br /> c' <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> F- e: Rnkcllnp S?rvices,!nc <br /> i Sri LAA Porte <br /> Facility's Phone: -Cp:I 42 i- 'r <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Now,Hazard pass,ID Number, 10.Containers 11.Told 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNol. <br /> rr 1f'l0r1'-RGR#Han-r• ous''AIBSt4:'-4itd i8ondo Lust) -r, <br /> o ~� <br /> 2. <br /> ONIHS SV 31SYM SK J, 3 a'd 111M 04V <br /> 3. i I IN -.- <br /> 'dd3`1�{�{� �O11Vr{MB` <br /> 1�rS�" <br /> 4. <br /> 14.Special Handling Instructions and Additional Information GrrL1�'.Dust-1-11 Feli 11 n3C7 ,.„ ? .i;�'•1(()-l' <br /> 15. GENERATOR'S/OFFEROR'$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, <br /> 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 <br /> Exporter,I certify that the contents at this consignment conform to the terms of the attached EPAAcknowledgment of Consent f <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)Of I am a small quantity generator)is true. <br /> Generators/Offerors P6ntedfryped Name Signat�r� o-" Month Day Year <br /> -j 1V temationai Shipments <br /> F mport to U.S. ❑Export from U.S. Port of entrylexit <br /> Transporter signature(for eDate leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedlTyped Name Signature Month Day Year <br /> Z <br /> Transporter 2 PrintedfTyped Name - Signature - Month Day Year <br /> 1-- <br /> 18.Dlsaepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quentily ❑Type [:1 Residua ❑Partiall2ejectlon ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J r <br /> U <br /> ! <br /> u. Facility's Phone: <br /> W 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> a5 19.Hazardous Waste Report Management Method Codes(Le.,nodes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> L <br /> 20.Designated Facility Owner or Operate:Certi cation of receipt of hazardous materials covered by the t except as nd In\@em 18a P, � <br /> PdntedfTyped NameI e I Mom Day Year <br /> rf r - <br /> EPA Form 8700-22(Rev.3-05) Previous edl ons are obsolete. p SIGNATEDCILITY TO GEN RATOR <br />