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Please Drint or t Form Approved. OMB No. 2050-0039 -- GENERATOR UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number (AEC- LOQ --& l''l I q (7 2. Page 1 of ‘ 3. Emergency Response Phone -io0 so 1.M if t -s L 4. Manifest Tracking Number 019704500 JJK Generators Name and Mailing Address Generators Site Address (if different than mailing address) TizAr-,-) ,.r-.1z-N-0.-N-1.4--) (1:,(7—k)V---- It-QF ‘'.." 7 C-4r- $,A7N-7•4•TECIls-, c_Ar Generator's Phone: (2-i) 1 1 4 • 4/-747 I Transporter 1 Company Name U.S. EPA ID Number .-J5t1-7.---1 ''1--- r-3 V \ I'Lri t•-. V \1.--_.- -v.D7-±11 -- t-- V.-- \.) S I C-tt- --, S3' iSV1O -1-9 ti Transporter 2 Company Name U S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number ..,,... -/-, ,,,,, .W. Facility's Phone: k.SA.-1) 1 .3--L.- S. \.k 'A S- ga, 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 (if any)) No Type Quantity WI.Nol. 1 n't--1› ) Oor--cs -p.m ,---%._k__ i --5 f T (-- k( 17,....i. 3. Special Handling Instructions and Additional Information - -z-)- 0. •,, `1,. -5 borz- P-1--‘ 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, ard 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 lathe terms of the attached EPA Acknowledgment 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 (if I am a small quantity generator) is true. Generators/Offerors Printed/Typed Name Signature Month Day Year 1 ‘ I q I tn-Ali _., 1- F._ International Shipments El U.S. Export from U.S. Port ent exit: Import to Transporter signature (for exports only): Date leaving U. t: Transporter Acknowledgment of Receipt of Materials FRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year --PC,t__-Nj_, 'clA. V---11r1 I ii - 'Milk 1 1 1 H 1 Vl) Transporter 2 Printed/Typed Name Signature ip Vir Month Day Year I I I I I *------ DESIGNATED FACILITY Discrepancy Full Refection Discrepancy Indication Space LI Quantity LII Type Residue E Partial Rejection LI• Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I 8c. Signature of Alternate Facility (or Generator) 'er-:If Month Doi [-I 19 Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1,1 j 1ii1 2. 3. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Rem 18a PrintedIT ed ame Signature_._------- Month Day Year evil 0 ilri I i e I (Z- 1 7-) EPA Form 8700 2 (Rev. 12-17) Previous editions are obsolete,