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Plses print o• (ypi; (Form desigrind for use on elite ( '1 "_-�,�Itch) type:vrite .} Form Approved OMB No. 2050-0039 UNIFORM HAZARDOUS Generator ID Number 2, Page 1 of o Em -rgencvResponse Phon�- � � - 'e 4. Manifest Tracking Number =• `- �. 01 68 6 9 6 0 3 JJK WASTE MAPlIFEST 5 Generalor'"amaand,T Mailing Addrees r, -, _ - - - c .1 , ' Generators Site Address (if different than mailing address) Generator's Phone: Number- 6. 7ranspo ta� ),pomparty` .PU .S. EPAID(ame , _ , L, U „ � 1, sVir, Jl 'll , icF , l 7 Transporter 2 Company Name U.S . EPA ID Number B. Designated Fadily .t�ame;andLiite.M&ess U.S . EPA ID Number Uil'il � lvi' U j I^ir; LIJUI`I _ 2 '0'00 Ni Al-MvI EDA S l PH I Oi;IFI 'JI') r% A JUSM { 'AT 8 � C1835 Facility's Phone: ( S1 C)52 1 1u0 ga 9b. U.S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 Total 12. Unit and Packing an 13. Wase Codes HM ig Grou P ,f( y)) No. Type Quantity WI,NoI. 1 UIt13J3 , WASTE FIV' N;1fvU; SLE LJOUIL PJ U . S . ( 3ASC) LhIt4 L9ctiE G001 � DO'!31 3-1, 3 �— VVF AIE ) 3 . PG II w Z 2. I 3. j 4 . r I � 14 Special Handling Instructions and Additional Information Ei:�IERGEPICY CONT. .CT ^ HENITr, ' L - U ,a , U � - O VY." ER • . EC 1 SOO 3 'JC ` PROFILE 1LE t J . r _ : B � _ G' L ; IdE , GrIESEL . +1= APPROPRIATE PERSONrIL PROTECTI 'V'E EQUIPP;IEI` I � q � = - 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 EPAAcknowledgment of Consent. I certify khat the waste minimization statement identified In 40 CFR 262.27(a) (if I am a large quantity generator) fl small quantity generator) is true. General . ' ffefor's fnntedJTyced Na Month Day Year y 11 � 16 International Shipmen s ❑ Import to U.S. ❑ Export from U.S . Port of enlrylexil: Transporter signature (for exports only): Date IIWving U .S.: w 17 . Transporter Acknowledgment of Receipt of Materials Tran der i PrintedTiyp d Namq Signature Month Day Year a ( L 117 arano odor T 2 PrinledrTyped N me Signature Month Day Year rt: F- 18. Discrepancy 18a, Discrepancy Indication Space Quantity ❑ Type ❑ 1 ❑ ❑ Residue Partial Rejection Full Rejection Manifest Reference Number: i8b. Alternate Facility (or Generator) U.S. EPA ID Number J V U Fablilys Phone: w 18c, Signature of Afternate Facility (or Generator) Month Day Year Q 2 19 . Hazardous Waste Report Management Method Codes (Le,, codes for hazardous waste treatment, disposal, and recycling systems) 0 1 . 20. Designated Facility Owner or Operator: Cedificalion of receipt of hazardous materials covered by the manifest except as noted In Item 18a PrintedrTyped Name Signature Month Day Year EPA Form 6700-22 (Rev. 3-05) Previous editions are obsolete. D .= S ) 0 , MATED FACILITY TO DESTINATIOI I STATE ( IF S; EQUIFtE D)