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SK SHIP# 232427916 <br /> Ple,se print or type. Form Approved.OMB No.20504 <br /> r 1.Generator ID Number 2.Page 1 of 3. m R s opse P.ho a 4.Manifest Tracking Number SKIS UNIFORM I;�;Cb>r.?f1i81 . �7�t }. - --rp,�}--1 1',J;? "' t " 18 <br /> SIMV <br /> WASTE MANIFEST 1)-7 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Ra9k Properties <br /> 115 Waterloo Road <br /> Generator's Phone: <br /> 6.T o` U.S.EPA ID Number SYSTEMS l:I+j(: T?'�?�21iti71�rrilc'.F�;a <br /> 7.Transporter 2 Company Name U.S.EPA ID Number - <br /> Ci..EhtN HArr'titO r_N'J '711, TN('., <br /> 8.Designated Facility Name and Site Address CI k AN HARBORS ENVIRONMENTAL SERVICES, IN U.S.EPA ID Number <br /> P247 5 H 16kWAY 71 <br /> i K I MPAL_I.. , Int£ 69145 <br /> :: 3d�8--�u5_•tt>��.c �'•i�::(7�pt t:�'=.'3513 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 3 HM and Packing Group(if any)) No. Type Quantity Wt./Vol. <br /> X 1• NA308-21 HAZARDOUS wt;,TE: LJOUID, :�*� t���= tltL'i''6 ti>�1t <br /> o N,13.S. (CHROMIUM, t_ AD, , S, PB III <br /> DOM D009 221, <br /> 1 Z 2. <br /> �. 0 <br /> ' 1 3. <br /> 4. <br /> 1 <br /> t <br /> 14.Special Handling Instructions and Additional Information r3D VY )34200583 RMG780f" <br /> ,:iM Eli RSC %Y#800-468-1'760._.CHiS;'(/TFI--Conrtract retained by gerier-ata; confers a envy author <br /> W' 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, <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 of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generatoes/Offeroes Printed/Typed Name Signature Month Day Ye: <br /> ry _j 16.Intemational Shipmeht$ <br /> ❑Import to U.S. ❑Export from U.S. Porl�f entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> t,J it 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> Transporter 1 Printed/Typed.Name SignatureY <br /> onth Day e, <br /> M <br /> a <br /> ZTransporter 2P'nted/TyMON eSignature Month Day Ye <br /> F _ <br /> j18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 3 <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Y. <br /> Q <br /> t <br /> ti19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> Printed/Typed Name Signature Month Day Ye <br /> EPA Form 8700-22(Rev. 2-17) Previous editions are obsolete. GENUZATOR'S INITIAL C( <br /> '&)8916669/2073289 <br />