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Vprint or type. Form Approved.OMB No.2050-0039 f5. ORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number ! STE MANIFEST - -- _ - 021323051 JJ erator's Name and Mailing Address _ Generators Site Address(if different than mailing address) Generator's Phony;:_,_-,_ _ 6.Transporter 1 Company Name U.S.EPA ID Number ,- 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Facility'sPhone- 1u- 1-a 47 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)) 13.Waste Codes No. Type Quantity Wt./Vol. Q. 1. f J:il .CRA HAZARDOUS,- .7E -3-07-ID, 100-_, D=E5-. `; 0 9 3Xz&/"p M 2. 3. 6 4. 14.Special Handling Instructions and Additional Information 98-111pROFILC# EFii:4`',:71 �j/ZQZO� Som Zc 5 d !..N. a;C.lf�lli:L;s'TeJii: 3ia.i ::<> Ct'3'iLilC�l+ti�hi%vi_ liP:NDLER�3 'SHOULD :3- . . `e k..""D 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 avid labeled/placarded,and are in all respects in proper condition for transport according to applicable international and n tionaI 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if] mall quantity generator)is true. Generator's er s dnted/Typed Name-, J Signature _- Month Day Year 4111411,Z16.Interna)iep*Shipments y r Importtc U.S. ❑Export from tlS'. Port of entry/exit. D ? Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials ry Transporter 1 Printe Y ype ame -s �/ Signature Month Day Year O Z Transporter 2 PrintedfType3 Name Signature - Month Day Year 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 Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2• 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Farm 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM