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Piese print or type . (Form designed for use on• elite (12"pitch ty writer. Form Approved, OMB No. 2050-0039 UW011 M HAZARDOUS 1 Ge ereto[ Ip Number 2. Page 1 of 3, Emergency Response Phone 4 Manifest Decking Number WASTE MANIFEST C?CJC� ' a M � Z - Ui6 371x747 0 ' 1 JJ K eneFator's Name a d Mailing Address Generators Site Address (if different than mailing address) Generator's Phoned/2 ok (44 6. Transporter 1 Company Name U.S. EPA ID Number f* J-+lr� y ri�i'. ' I ir�ff6lti: hf'fr' .t . ii : i": , ! t ' f `. . r• . 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address -14; i `. �4 ( 1ita _ � � ,, ' _ , • U.S. EPA ID Number Facility's Phone: 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 • Total 12. Unit, HM and Packing Group (if any)) No. Type Quantity WI.NoI. 13. Waste Codes i 0 1 . u aJ 13 at5� WrisCxrr�, �� 1 SULr u r�,c'�K.�7rJ ; �, N ,o , s . , i u ZIL / tom'- E /LoGGi+•� r-� [�r'S wl 's f co I D wt �r' + 0 l� f�c�� �. }-- -- Z 20 LU Ark 16 W � 14. Special Handling Instructions and Additional In rr ((a on ' 91301 0400e '? r'it '� fJ f7k+ � WNJ'40 .ER;3 1'0 UE TRA NE"O AND USE fuPAftOVED PPE , I E . R. t:OITI'RACTOR: RAIT10S ENORONNIENTAL SEIRvI Fi.. r t;+ / /`�. 15. GENERATOR'SIOFPEROR'SCERTIFICATION: Thereby 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 =xport shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent, j 1 certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quanlity generator) or (b) (if I am.a-small quantity generator) is true. Generator'slOfferoes Printed/ryped Name Signature Month Day Year fi 16. International Shipments 1— ❑ Import to U.S, ❑ Export from U.S. Port of entrylexit: Z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Ackoowledgment of Receipt of Materials I Transporter 1 Printed/Typed Name 1 � Signature G � _ Month Day Year .• Z Transporter 2 PrimedlTyNa Q � Signature Month Day Year 18. Discrepancy ' 14 Discrepancy Indication Space quantity ❑ Type Y ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifesi Reference Number: 18b. Alternate Facility (or Generator) , U.S . EPA ID Number U LL Facilitys Phone: H18c. Signature of )Vtemate Facility (or Generator) Month Day Year Q , Z US19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) � LU 1 • ' 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 Signature Month Day Year (• • EPA Form 8700-22 (Rev. 3-05) Previous editions are obsgete. DESIGNATED FACILITY TO GENi= ts 41'(}