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P609 print or type. Form Approved,OMS No.20500039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2,Pape t of 3.Emergency Respome PhoneT00178587-1 <br /> Alen t Tracking umber <br /> WASTE MANIFEST VES <br /> 5.Generators Name and Melling Address Y{1I]>SISA CIALVA1li Generatoes Site Address(If different than mailing address) <br /> SM�f�011lliD SAIIdB <br /> FAM WAY <br /> ra� 9s377-T317 <br /> 6.Transporter 1 Company Na U.S.EPA ID Number <br /> N 3 D 0 S 0 6 3 1 3 6 9 <br /> 7.Tremporier 2 Company Name U.S.EPA ID Number <br /> 8,0,03 gnaled Facility Name and Site Address U.S.EPA ID Number <br /> V=AES'®Cll>WAI.>1O13TP1S, <br /> LLC. <br /> 1143 HMN!l W STMM <br /> Fact' s Phone: cin Rte.CA%01 <br /> 9a. 9b.U.S.DOT Description(Gndudirhg Proper Shipping Name,Harand Class,ID Number, 10.con n; 11.Total 12.UnR 13,Waste Codas <br /> HM and Pad ng Group(d any)) No. Type Gummy Win& <br /> t. NWWKMAHAZ0 X X WASH LIIQ BD,(I,ATIM PAW, NONE <br /> OIL) <br /> 1 D F 1 9 0 P 331 <br /> z 2. <br /> LU <br /> cs <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> 11"tyenh" (a '11-1 b" + 1 W,7J3NA- <br /> 15. OENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the wntents of this consignment are futlyand accurately described above by the proper shi <br /> Aping name,arra are classified,peckeged, <br /> marked and labeledlplacarded,and are in all respects In proper condition for transport acceding to applicable htemalional and national governmental regulations.ff export shipment and I am the Primary <br /> Exporter,I certify that the contents of this eonaigtment conform to the terms of the attached E:PAAdmoMedgmwt of Consent- <br /> I certify that the waste minimization statement idenbW In 40 CFR 252.27(x)(If f am a large quantity generate)or(b)(III am a smag quantity generator)is true. <br /> GeneratoeslOfferoes PrintedlTyped Name Signature Month Day Year <br /> Ir aUAM OM o 412 a <br /> _j 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U,S, Portof entrylexh: <br /> i Transportersignature(for exports only): Data loavinp U.S.: <br /> CS 17.TransporlesAdmaa{adpman!of Receipt of Materials <br /> Tram"r 1 PrintedlTyped Name Signature Month Day Year <br /> gamy(xv 0 4 12 II P 1 <br /> z Transporter 2 Pdnted/Typed Name Signature Month Day Year <br /> t8.Discrepancy <br /> 18s.Discrepancy Indication Space � Quantity ❑Type ❑Residue ❑Partici Rejection ❑Full Rejection <br /> I <br /> Manifest Reference Number. <br /> 18b.ARemale FadUly(or Generator) U.S.EPA ID Number <br /> V <br /> U< Facility's Phone: <br /> ILJ <br /> 18c.Signature of Akemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> o t- 2. 3. 4. <br /> 20,Designated Fadgty Owner or Operator.Cetificatlon of receipt of harerdow materials covered by fha marffestexcept.as noted in Item 189 <br /> PnntedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12.17) Previous editions are obsolete, DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />