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t Form APPraved.OMg No.2050-0039 <br /> Please print or type. q,Manifest Tracking Number <br /> UNIFORM HAZARIDUS t.GanureI r lD Nvmer r)(` j 8 9 2 6 j�K <br /> 2.Page I of 3.Emer�gyency Response Phone �v <br /> WASTE MANIFEST ���(_ rl C :.� j q/�"1'F1/ `S f�7~ <br /> 5.Generators Name and Mailing Address p r <br /> �) rens(if dlffnrent than mailing address) <br /> ('0oF2L L7 Fl.[[9/;7— <br /> �1;7a5 s. S. s7'fr ;- <br /> Generator's Phoney "i <br /> 6.Transporter I Company Name <br /> U.S.EPA ID Number <br /> RANX) FNM1nRilNlgt�MAl 4}°!�'.Ii:H tP}0 U,s.EPA ID Number <br /> 7.Transporter 2 Company Name ' <br /> R Designated Facili y Name and Site Address U,S.EPA I p Number <br /> RAiii t tYkil 9FfTy.4t.li Irk, <br /> 151 .I,11 rill°}'f+,RI) <br /> W'`,L'T �tt;fntilF.IV1;�?,C:4 b+56AI - <br /> Faci :s Phone:01ill Z&A, <br /> qa, gb.U-S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1i Total 12,Unit 13.Waste codes <br /> HM and Packing Group(If any)) No. Type Quantity Wt./Vol. <br /> o WON ii 1442AIFDQIt$WAVM LK)lFlq ilW�,i;D 0K,) � I1 <br /> r— <br /> Q ' <br /> w <br /> z <br /> w <br /> G <br /> 14 Specia anft Instrucil and Additional Information _ <br /> R 'pi4ACFt]R: fsAM�S E P 4 llll f.AL.Sill <br /> �rt►�D;ERS 5HCJU1.D BE TfoAWD .AM LI;;E APPRO'ii ppp <br /> GENERATOR'slOFFEROR's CERTIFICATION:I hereby declare that the contents cf this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged. <br /> Mile:2r-.0 Iabeh--bcacarded,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 /> Fxpone- rF,•M that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> l 051A lira:the waste minimization statement identil 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 /> GenerawrsvOfrerons PrintedfTyped Name Signature Month Day Year <br /> r <br /> J 16.International Shipinents - <br /> N `❑Import to U.S, ❑Expod from U.S. Port of enlrylexit <br /> Transponer signature(for exports only) <br /> Date leaving U.S.: <br /> W 17.TransporierAdunwledgrnent of Receipt of Materials <br /> Transporter 1 Printedlfyl Name Signature Month Day Year <br /> O <br /> z Transporter 2 Prirrtedlfyped Name Signature - - <br /> � Month Day Year <br /> 1B.Discrepancy <br /> 18a.Discrepancy Indication Space puanMy <br /> Type ❑Residue ❑Partial Rejection <br /> ❑Full Rejection <br /> Manifest Reference Number <br /> 7Bb.Alternate Facility{or Generalorl U.S.EPA ID Number <br /> J <br /> U • <br /> LL Facility's Phonal: <br /> y 16c,Signature ofAltemate Facility(or Generator) <br /> sMonth Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2 3. <br /> 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 <br /> Month Day Year <br /> 3 Form 8700-22(Rev.12-17) Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />