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RECEIVED BY SJCEHD (EF) ON 3/9/2020 <br /> Please print or type. aA <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 G�perr�pIqr ID Numb 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number y y <br /> WASTE MANIFEST [-%!,l_�--- g 9a8 --0021323914 6J <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> _ _ _ <br /> Generators Phone!:' 5? ? <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> .�J%i•._ -,.il,:�l':'li�,. ._J-r ,.�=_ ...�. �.i:__.. ___moi <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address, U.S.EPA ID Number <br /> Faolily's Phoned'--4SCZ'! <br /> 9a 9b.U.S.DOT Description(inducing Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type OuanUty WINoI <br /> 1 vtll__-, rL�:=isG:4SC1_ir=, ?Gii <br /> 0 <br /> z 2. <br /> W <br /> 0 <br /> 3. <br /> I <br /> 14.Special Handling InslruclJons and Ad iGonat Information <br /> mai _= — L7:.•_ Cy ' J <br /> (:i i�•7 —_"1 ji�J ry.l?) L:.i� <br /> L.i.. LUIJI�.�r�l J:-.. .�.ili•r:J r��•r�,,.,,...C:l: -� .J- ,v._ �//- SS <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of(his consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledtplacarded,and are in all respects in proper condition for transport according to applicable inlemational 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 EPAAcknowfedgment of Consent. <br /> I cerbly that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantitygln rator)or(b)(if I a a small quanUty gerera(or)is Uue. <br /> Gongrators/Offerors Pnnted7Typed N me gn lure Month Day Year <br /> 16.ntemaUanal Shipments <br /> i` <br /> E]Importto U.S. ❑Export from�U.S;. Port of entry/exit: <br /> ? Transporter signature(far exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of MaterialsLLI <br /> Transporter 1 Pr nled/iyped Name Signature Month Day Year <br /> O ^ <br /> M .�-- �-✓ - :-..-� � _ _ l^ � .112 08 `La <br /> z Transporter 2 Printed/Typed Name Signahrre Month Day Year <br /> I- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El <br /> Quantity El Type ❑Residue ❑ParOal Rejection El Full Rejection <br /> Manifest Reference Number: <br /> F— 18b.Allemate Faality(or Generator) <br /> U.S.EPA ID Number <br /> J <br /> U <br /> LL Faalitys Phone: <br /> w 18c.Signature ofAllemate Facility(or Generator) Month y <br /> Da Year <br /> Q <br /> 2 <br /> Cn <br /> 0 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Uealinenl,disposal,and recycling systems) <br /> 0 1 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br /> Printed7Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DESIGNATI=I1 PArn ITV Tn PPA'c a_ennhllt=r-qT cVCZTrgn <br />