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5--j-Ye,�- 21) 3333 FPlease print or type. Form Approved.OMB No.2050-0039 UNIFORMARDOUS 1 enerator ID Number 2.Page 1 3Emergency Response Phone 4.Manifest Tracking Number NIFEST ( 00 3LIDa006195352 GBF me and Mailing Address Generators Site Address(if different than mailing address) ,,yycc�k-I OWLc rw Generaton'�Pfidi�:�, c,4 q�34& •5�Ci—Q y I 6.Transporter 1 Company Name _ U.S.EPA ID Number i! NU t ,1 LO C)3011 L) 7.Transporter 2 Company Name U.S.EPA ID Number 8 D i ted F ility Name and Site Address EPA ID Number Tv Kr0"q '(r 1,IN o AAV OVtO k rv�g 3. o k'/1,140 r.\0.. t..�.c, POCAS A1C-)W,65 �r �}- _ Phone: 1 (�1 t�V Facilitys Phone: ��5 � � _ �G p l AJ 0(,i 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Container 11.Total lJ 1_21.OUnit JO HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. Il1aN �-►� Ned wc� Sd� d Sa i �u�Sorbeti} C I w �i ctic,l � CS� 'C�n1 � + z z. w u) 3. ------ --- 14. -14.Special Handling Instructions and Additional Information S � 9�G �Jo3x5sD►r. l�• �GG9 C3 �alsGRye, - 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately dXledve by the proper shipping name,and are classified,packaged, marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and namental 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 all quantityr)is true. Generatol ror'sPrintedl dflame Signature Month Day Year 16.International Shipme K ❑Import to U.S. ❑Export from Port of entry/exit: Trans porter signature(for exports only): Date leaving U.S.: W 17 Transporter Acknowledgment of Receipt of Materials LU OTranspo 1 Printedffyped Name Signa Month Day Year a dq cls O C* Transporter 2 Printed?yped Name _ Si re Month Day Year 18.Discrepancy b b 18a.Discrepancy Indication Space Quantity (;Ptl ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) �\ r /Manifest Reference Number:r('C,�11 v -1 ` U—C- U.S.EPA ID Number Ic LL Facility's Phone: �J G L r 1�j, 1 1 w 18c.Signatur ernate Faciliry1pllenerato f" J V Month Day Year Z � I , 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 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 Pr nted Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM