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Please print or g N 1 r) p type. Form desi ned for use on elit (12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 700848.10`96 .1.Generator ID Nu bar 2.Page 1 of 3.Emergency Response Phone Manifest Tracking Number WASTE MANIFEST JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) -;AJam'•C.:�!'�, _ '-e ''i? 7 + '.7� Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ;,_?UW ENVIRONMENTAL SERMES INC TRAM4 G A R 0 0 0 1 7 1 0 1 7 7.Transporter 2 Company Name U.S.EPA ID Number �t ..F! 4. iti i'fl4 E T 1' i" to it i el Ft 1 i _ 3 8.Designated Facility Name and Site Address U.S.EPA ID Number US E(X)LUGY INC HWY 95 1 IN S OF CY tai AC ES BEAT'rY w acxW, Facility's Phone: y iF y iki f ga. 9b.U.S.DOT Description(including Proper Shi)ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. a -hitt► fs `}1 i fiAit18 A-65.i..t ::SC3t Ifs iC31 V' r�'fS. Z 2. 1 w 3. 4. 14.Special Handling Instructions and Additional Informat 3n r.: r.rttaact-• � -urn-r�•rrr,+rnu;r. a na u, , 15. GENERATOR'S/OFFEROR'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 respec s 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 consignmE it conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identii ad in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Print edlType-d Name Signature Month Day Year •`-.fiery -i 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedllyped Name Signature Month Day Year O 1�...� y CL QTransporter 2 Printed/Typed Name Signature Month Day Year H 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 J V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year !;-c N19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1• 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of r ipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsi lete. GENERATOR'S INITIAL COPY