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II�ryllt .. ! t 4 Please pont or type.(Form designed for use on elite(12-pitch)typewriter.) r..t?��-r � }:-�^ a�-"*r 1.-� -��' Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number F�Pa,e 1 of 3 Emergency Response Phone 4.Manifest Tracktn Number WASTE MANIFEST =1,.rcix°7f'` • ;f': i2tt 's: !.^ t�"`'r 011392812 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) titl,l,je-11 'rax ley iesV ,".,Yp11 Generators Phone: c , :,_ ;, 6.Transporter 1 Company Name % .S.E ID NRber_.._ _ n 41 „ 7.Transporter 2 Compan ame "- ' ` U.S. AID Nbrmber ' 8.Des a ed Facility Name and Site Address 1 U.S.EPA ID Number x e V, .t 1 e >i' t. FacilitysPhone. il 4,: 9a. 9b.UA-,&O D s riP n(incudin 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 Wtivol. 1. 0'� . ,:�'-1s<Z, t,jtt t ,. z. l`_ .! r 1' 1! rdsiC;l..l3p _ rlt.ltr;:i<7. u,}i k r�.r. t. �S rt 1. l,3 C.f.'i f I) liJ Z W C7 3. 4. 14.Special Handling Instructions and Additional Information 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 labelediplacarded,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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am o Im"fill quantity generator)is Wu A' eneratoes/0 eror's Printed/Typed Name bignature Month Day ear k -j 16.Int rnation I Shipments ❑Import to U.S. ❑Export from lYS._-1 Port of entrylexit: Z Transporter signature for exports onl : Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 PrintedfTyped Name Signature Month Day Year CL Z Tfan3 er2'PfinfedfTypedN m " 1 ignalure —7 ______ -� Ir°Month ay ""'gar' 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ElType ❑Residue ❑Partial Rejection ElFull Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number .'- U Q Q Facilil s Phone: Lu 18c.Signature of Altemate Facility(or Generator) Month Day Year M Q .z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. { f`f 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year / s AForm 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED)