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Please print or type. UNIFORM HAZARDOUS 1•Generator ID Number Form Approved.OMB No.2050-0039 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAR00076522 5.Generator's Name and Mailing AddressFLE LfE'r �"S)D.�f�H:r7➢�i SC)L TION a _ STEM-Wn3g Generator's Site Address(if different than mailing address) P' NAL Generator's Phone: 47'i 6.Transporter 1 Company Name AT.D: CL'wA7d )dx"��7f�'3}C1Ct s WJL11r°CE' RF-MS,.AL JuC U.S.EPA ID Number 7.Transporter 2 Company Name C"A09 8 2 4+323 9 9 p�_f 1.M RY 9 ,CY y �+•q�� -�*�p U.S.EPA ID Number •.G LL'.E•"kJ�lC d LLE1•v 1:1.�J..iY'1!•..Y 8.Designated Facility Name and Site Address £% 00l134�3 217i➢.'. dwl.e61)RA 'T .t`il'tRDY Dom" ;N➢F_?TC'f) U.S.EPA ID Number t'wARTZi7D`t.lZA . F`'T Dt1 gAji DECD. 2 W-1, SAM PRial,ill I•i`!'AT€. BC Facility's Phone: 61.9 _2^70-94x;3 9a• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit No. Type Quantity Wt./Vol. 13.Waste Codes 1. �+ li 3a IX'Ii.�i 5;i� D:IG d3C:AIi, b;[tilk➢t1'Cf > It pr..Tr D002 791 z 2. W 0 3. 4. 14,Special Handling Instructions and Additional Information y 'y -0 Ell-9...2169 7Ti DE. AB tdtq.L'tltTlg IJ lF d,I. IT) W-L CLEAAU P00 178-47-1 T'FS 07rTt3Z:>EV,1>N POO 132: TEMARi`°+< RECTO YNG INC 026074/9E1 0, 02F07 /. V/20, 025267/5E/20 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 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 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 I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year ,j 16.International Shipments Z ❑Import to U.S. ®Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLJ1 Tran iter 1 Printed/Ty ed Name Signature / Month Day Year ", -•fir... •; 11'",rP'°r•.r+. 9��'-,:..;., -"�7+.e.• dna A� ' ��f 2E Transporter.2 Printed/Typed Name Signature Month Day Year H 18,Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection F 18b.Alternate Facility(or Manifest Reference Number:Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of alternate Facility(or Generator) Month Day Year Q Z C- 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 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 Form 8700-22(Rev.12-17) Previous editions are obsolete. rcrreo eTnn�c+....T..