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r 40y 77 <br /> 4616-1 J' .3 3 1ti00? <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest TrackingNumber <br /> WASTE MANIFEST u`riR.ElLs�'�.'93932 !877) 577-21531000 2 0 0 2 7 DAT <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> CITY AU COUNTY OF SFtFUC THU F€UL-1111 CUT RK2 COUNTY OF S3-PUC T�QCY FRULT_TY <br /> 11:50 12RKET STREET, STE 21,2 41999 BEST VERNRLTS R09J <br /> I X5 <br /> HCTSC v, a i111J �Si .f37l 'RACY r� 13 <br /> Generator's Phone: �R ;1`I� <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> .S3T .S BICYCLE ECIAI-TY WAS _ �; �� .-. .. Iil~fflQI7fl11D�?2�. <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 /> 21995 NeViands ➢ .ave East <br /> Facility's Phone: -7R%LEY, NY K94RK [775) $7-51-27H NVD98089533 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Code <br /> No. Type Quantity Wt.Nol. <br /> 1. <br /> 0 O <br /> ZUJI <br /> 2. <br /> C7li.VoA!vse1 RIC Fitr11, SIRTK h :rRvL"J I E) 8 PST! <br /> DFS <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> . .,v.,.. rt�;r:a -3 - E"fs�TS�r) RYTx �df t IR= _ Cw , - �I <br /> .0 �s Few -� 1#�3II- II;CL"tiI5 rL <br /> 15. GENERATOR'SlOFFEROR'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)df I am a small; tity generator)is true. <br /> GeneratoeslOfferor'g Prints ped Name Signature M.-^h Day Y <br /> 9 <br /> 16.Internationals i ments <br /> P- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> f- Transporter 1 PrintedfTyped Name Si nature <br /> � 9 Month Day Year <br /> As r7 ti <br /> ZTransporter 2 PrintedlTyped Name Signature Month Day Year <br /> f <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone: <br /> w 18c.signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 2. T <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />