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Please print or type. Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3 Emer ency RMO gP one 4.Manifest Tracking Number CAliN4jc:,ifill -46tl1LI 008029158 SKS WASTE MANIFEST 5 Generator's Name and Mad ng Address Generators Site Address(it different than mailing address) QCJICn In[yY@[l.10T1 it1C Hox 619 AttnI Roper, HDtrtoAh 1r1.'1 lndrlstr ial Dr 51 ULt11iJN LFI Generator's Phone: Ecy— fh j G4?1d 6TC)Lt',T ON CA s`-r ob-3-K,8 6.Trd QB Co(npany Name U.S.EPA ID Number 7.Transporter 2 Company Name �USA ID Number CLAM NAI;: 5 %.irV 5VC iN{, i� �"4a:1- 8.Designated Faahry Name and Site Address r U.S.EPA ID Number Ct I•'r1 ! �S L)F 1;U1 It,,�,tYILLLIIfJ BU i TONW,ILLUN Gla X 406 b61-762--6cE,0 LAD',606 'j;'7ia Facili s Phone: ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1Ix1•?fr'ht NON RCRA ialAVIRDCUS 14142-7,1Z SU'-IDS, ��'j P �5c o ts,uSilRBENT AND OIL), .N4- w 3. 4 i 14.Special Handling Instructions and Additional lnforma6on T 5D e KL ,;if t67; C F J i•y 1,F EJ fr S L i 2'Ch Ei*IEF.3ENCYA&kli—viiks-17E0-•CHiSK/1FT n;.r .rFt 1-2 gc . L�r ^}- , •' r - i s o -:40e, c i t- i L I -�7'-i r, -1 1 q Ljr#rlt 0 i`t n rl i❑r.G y A 1 f-•i Q ,-�;. 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 and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,1 certify that the contents of this consignment conform to the temps of the attached EPAAcknowledgment 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'stOfferors Printed/Typed.Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Expert from U.S. Port of entrylexit ? Transporter signature(for exports only): Date leaving U.S.: Y 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year 13- Zz Transporter7Printed/Typed Name Signature Month Day Year K F- 18-Discrepancy ' 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V ua- Factily1s Phone: 18c.Signature ofAllemate 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 i8a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY 7.1 rci=- i1 71