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y +.11l � l� 111 lfll lllll� l 111 Y For & A oved. OMB No. 2050.0 9 Please print or type. {Form designed for use on elite (12-pitch typewdfer ) kt. t _ r t w ppr UNIFORM HAZARDOUS 1 Generator 10 Number 2 Page 1 of 3, Emergency Response Phone 4 ManifostTracking Number WASTE MANIFEST cr1111`;'Rrtr'}:1 r ':i"r L' ( �11�'r�rot !?E� a 008549969 FLE 5, Generator's Name and MailingAddresS Generators SdeAddress (it different than mailing address) ':'� � 'A %44 #� Cf ,a3' ;( r �. '. w ! .C :. } #tthruav r. 'wtfM .S'� «s:� i #3► l '; i t ' ca* k += i » A : t: s wr1X1 E eOk « �ri' CC [ E1E [� : L' r r_ frxtsl } + GeneratoesPhone; 8. raasporter I Company Name U.S EPAIDNumber ` , attrti xrvcae artCCxrdti° WaTtL4 txl (at tIc' AS IIII c C+tN: 030110 +� X 7. Transporter Company //Name /� / U §T/PA(ID Number IV (; / tYf r L ! 21. � a3 ��6G IW / ��(J?/r-�e#VW4 40 7-' ` l4 �r P / ✓I l� G ( Vr ,r B. Designated Facility amaandSieAddress '*1W + CI :4li, t..tr •. & rs+ t ► tu % k4 'UUa irylrg t»t»« U,SEPAIDNumbet 11855 t4hiat » Flock, Vou;ld # ' 1T} tho FadlNyfa Phone; '� i t_ 9 M LAY GA ►`�t! ±;3»+ ga, 8b, U.S, DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 1o, Containers 11 Total 12 Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt Nor. t 1lI(`�! :•tw' •tJo ( # ,Lir• I ' >`' a .txl ► ip L.; ust f.t7R'f`, !ano ,3 , 1 trh � Itc'};tJ' 411 I^ti 311 f C1� 1 t'�£� itl '1� 2i6p + CJjcj , tat= ) L: , 1'1 % La1.' • '( Wdt" fat tnJix ( +• 1K k 't,r L tt I_# 'u#5: 1 � 1 Ll �. 1('1� t3lI , ( 11at: 2 jut xc IglJos � vY1g�rii .: ,` no itoo 1 CF' 1300103 P :: 11 11107 +010 ( Crh #• tri� x ►.tta . 61, a0121tra ) 4 3. 4 to 14. S eecialHendlmglnsiruc8onsandAddibonalinformabon ( ^ 1k+ 1 1 � (: � dk *J ►.te q} eir►ht doeot not >; . Cead 0 .. 044+6 Iiia t 1ft7r i~,,° 143L1f�� ( I1x ! U .' 3CGXxltE 10 It 45, GENERATOR'S}OFFEROR'S CERTIFICATION: I hereby deptare that the contents of this consignment are full and accurate) described above b theproper shi m name, and are dessiried, packaged, g Y Y Y shipping P 9 M marked and labeledfplaarded, and are in ail respects In proper condition for transport according to applicable international and national governmental regulations. R export shipment and f am the Primary Exporter, I codify that the contents of this consignment oonfoml to the terms of the attached EfP4Aeknment of Consent. 1 certify that the waste minimization statementldenbried in 40 CFR 262.27(a) (if I am a large quantity generator }(i6lam a small qua bty"ge`1ei rat s bu Vo ra(o s 0 eP to yped r5@ l /'r - ' r + � 1(fl rgna ure - n ay ear 1]V 11 Jl/. YII (/iJVA'/ V L # l3 'fit Y. 6. Intgrnati0 al hipments El import 10 U s ❑ Export f4 U.S. Port exit iE •Trans orters1 nature for oxiLortsant ; 0ale leaving U,S . 17. TransporterAcknovdedgment of Receipt of Materials n a TransportorI Printed[TWed Name nature ont y ear a fiT►itln) r# s' IrEsTt F. I &(/Vl t # 18 1?016 Transpoder2 PrintedfTyped Name signature \tm Month Day Year 1O. DiscretAncy 18a, Discrepancy indication Space Quantity Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) US EPA ID Number k Fadb s Phone° r w 180 Slgnalure otAltannato Facihly (or Generator) Month Day Year a 19 Hazardous Waste Report Management Method Codes (I,e„ codes; Whazardous waste treatment, disposal, aid recycling systems) 1 . t4 J 2. = t 3, 4. 20, Designated Facility Owperor Operator Cerbr ation of receipt of hazardous materials covered by the manifest except as noted in item 18a P I . T400rovl pad Name Stgnature z � Month Day YQar : , ) C ) e�PA Form 8700--22 (Rev 3-05) P evious editions are o Mate DESIGNATED FACILITY TO GENERATOR STATE OF REQUIRED) 07010 -tVil' IZ! v < LAL &EML'J0641 s41LN27319 # t }l� 't3w #�c3 hi r101ILatri r �oil1 it.. � 04 t