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Please pint or". � � � IForm Approved,OMB No,2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Mantlsat Tracking Number `/ <br /> WASTE MANIFEST 1001796186 r ES" <br /> 6,Generator's Name and Meiling Address YEKAX"GAr-"K Generators Site Address(tidifferent than mailing address) <br /> PW FIX GROURD NAhM <br /> 36M Imn WAT <br /> WM 72117 <br /> ne.1, e: <br /> 6.Transporter 1 Company Name U,S.EPA ID Number <br /> 7.Tfenaporter 2 Company Name U.S.EPA ID Numbar <br /> 8.Dealgnelad Facility Name and Sita Address U.S.EPA ID Number <br /> VEOLtA 89 TOCHNU".AL SCIL nIOM <br /> 1135 SRT� <br /> Facil s Phone: CA % N2 C A T 0 aZ b 0 1 4 0 7 9 <br /> 98, 9b,U.S.DOT Descrlptbn(Including Proper Shipping Name,Hazard Gass,IO Number, 1D.Containers 11,Total 12,Unit <br /> HM and Packing Group{f any)) 13.Waste Codas <br /> No. Type Quantity "im. <br /> X 1' UKIM WAEMP MAKI,V DW1 . <br /> 1 C Y P X31 <br /> x 2. UCW%WAM MMOW CKM 2,.2(J.7) i]QOl <br /> 1 C F 10 P 341 <br /> X 3 M04 C'hYH;tlB MWIQK�2.2 yy3 <br /> 2 C T 2 P <br /> a. <br /> 14,Special Handling Inawcifons and Additional Infdmation <br /> �A 'l k13R[t972A61 A�L�AIICASI4'1 Y)�f�1W(1 -}- <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accumteydesc ibed above by the proper shlpping name,and are classified,packaged, <br /> marked and tabeledipiacarded,and are in 0 respects In proper condition for transport according to applicable fnternationaland naWnat governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAduwwledgmenl of Consent, <br /> I certify that the waste minimization statement identilled in 40 CFR 262.27(a)('d I am a large quantity generator)or(b)(U l am a small yuantiy generalar Is true. <br /> Gen ralorsl0ifarors PdntadlT Name Signature Month Day Year <br /> V 1ti5S14 C,� IV AI <br /> r 16.international Shipments <br /> ❑Import to U.S. ❑Export from U. . Port of anbyfaxit: <br /> Transporter signature(for exports only). Date leaving U,S.: <br /> tY 17.TransporterAcknow{adgment of Receipt of Materials <br /> Transporter 1 'ntsdlTyped Name Signature Month Day Year <br /> Transporter 2 Pdntedlryped Name S#Jnatuk Month Day Year <br /> F <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantify ❑Type ❑Residue ❑Partial Rejection ❑Full Rejectiort <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA M Number <br /> J <br /> U <br /> U. Fadlitys Phone; <br /> Signature ofAltamale Facility(or Generator) Month Day Year <br /> z <br /> 19,Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste lreatrrwl,disposal,and recycling systems) <br /> 1. 14/ 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as ncled in Item 18a <br /> Print typed oma / Signatu Momh Day Year <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />