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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST 002010365 VES 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) FM EX 43RDLWD M05EOMWAY SAME GenT e$ r�Trrs P A 93377-7217 6.Transporter 1 Company Name U.S.EPA ID Number VIDUA Ba T BOUNICAL#O=CM IN I D 0 9 0 6 3 1 3 6 9 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number VBOEL 1l ffi TBC120C'.AL SIL L I.C. IM fERILST Irmwr Facility's Phone: - l 11%CA NMI C A T 0 A 0 0 1 4 0 7 4 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(itany)) No. Type Quantity Wt.Nol. O Y U014K AMCL�.PRUNLMM P ATfC 141 Ow - C OMAD046 NON-rLAN tAHM GAL 2.2 2 C Y 111 F X 2. MM WI M 0011111108Mrs o, D= HY=X=BODI[M HYPBOC ON A.%RQ 1 D F 1 6 3 P 172 3. 4. 14.Special Hand_liling�Instructions and Additional Information tR *d by t> by ¢ aMdo rZca� 154 1 - ID ft cr PTAVS$O (M -!- 1)�' 'M W916M 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arca are classified,packaged, marked and labeled/placarded,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(a)(if I am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Generator's/Offe s Printed/Typed Name Signatu Month Day Year A - V I 210 I 12 F 16.Inte atonal Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials ui Transporter 1 Printed/Typed Name Signature Month Day Year a / v � Z OI ZI zTransporter 2 Printed/Typed Name Signature Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space Type 1 ❑Full Rejection Quantity T Residue Partial Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: W 18x.Signature of Alternate Facility(or Generator) Month Day Year Q Z r19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU ,. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/typed Name Signature Month Day Year Afe �,` r�u✓ci 1 Z Z EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM