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g�aaa <br /> �IIil�lll(�II�IIIIIIQI71�1� ' <br /> Please print or type. Form Approved,OMB No.2050-003@ <br /> UNIFORM]JAZAR©OUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4,Mant est Track ng Number <br /> WASTE MANIFEST 001796278 VES <br /> T.Generators Name andMallingAddressYY 6A0 VAK GenaralosSite Address VI'diferentthan mailing address) <br /> FED EX C>IROUM SAM <br /> 505B=WAY <br /> Gane�relofs`ACA 93lJ-397 <br /> 830 113a <br /> S,Transporter 1 Company Name U.S,EPA 10 Number <br /> VHDLLAEB TuammaLsoLQ1T4f1+18 3 6 9 <br /> 7 nsporter 2 Company Name U.S,EPA ID Number <br /> gnated Faollity Nama and Slte Addr ss U,S.EPA ID Number <br /> »H�AY73 <br /> 3.s muM W.(w TAnDWS BATOu <br /> Faclli s Phone: AM PC=ARTIM TX 77MO T X I7 0 b 0 ! 3 a S 0 B <br /> 8a. 9b,U.S.DOTDescriptfon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containors 11,Total 12,Unit 13,Wast?Codes <br /> HM and Packing Group(If any)) No. Type Quantity W(JVot. <br /> X 1. U0173,WAMIOLM CMAMM FL&OLQ 8 8043 332 <br /> F �C�iNTAm7Am wr <br /> \►�11'8j,a-am'.4, ,II i D F 6 8 P =I w1v ow <br /> 2' NON-RMA HAZARUM WAUE EZQ= q A`l X PAWr 331 <br /> 2 D M 436 P 19EI <br /> 3. <br /> 4. <br /> 14.Special Handling Insbuctions and Additional Informagon W BMW opftww by VEM 0~ wAr u� <br /> 1� <br /> A A� )W� ar ftm ofti d pwitrsn an paat�a 1st[ 1)�W11349 k <br /> i <br /> is. GENERATOR`SfOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this cnnslgnment are fully and accurately described above by the proper shipping name,and aro classified,packaged, <br /> marked and tabetedlplacarded,and are in all respects in propercondition for transport accarding to appilcable International and national governmental regulations.It export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknDWedgment of Consent. <br /> I certify that the waste minimization statement Identified In 40 CFR 282.27(s)(if I am a large quantity generator)or(b)(dI am a small quantity generator)is true <br /> Gen aer torisfOfieror`s Printedlryped Name Signa Month Day Yeaf <br /> 16.International hlpments <br /> ❑Impart to U.S. ❑Export from U.S. Part of enbylexll: <br /> ? Transporter signature(for exports only): Date leaving U'S': <br /> W 17,Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> r Transported Pdnted/TypedNome Signature Month Day Year <br /> a 74i0L BL D6 4- 0 112 <br /> Z Transporter P'n dfTypefi Name Sign ure Month 0 y Year <br /> A)r <br /> 18.Discrepa cy <br /> 18a,Discrepancy Indication Space ❑ Quantity []Type ❑Reslduo ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> 14� Facility's Phone: <br /> juu 18c.Signature olAllemate Facility(or Genarator) Month Day Year <br /> I <br /> Ha dous Waste Report Management Method Cndes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. ' <br /> 20.Designalad Facility Owner or Operal :Certification of receipt of hazardous materials covered by the manifes sept as Wed In Item 18a I <br /> Name yr on Day Year <br /> . <br /> EPA Form 8700-22(Rev.12-17) Previous editions ar obsolete. DESIGNATECT FACILITY TO EPA's e•hhANIFEST SYSTE <br />