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- -- illlli81111�1�lllllul��i 0072756045KS Please print or type. Form Approved.OMB No,2050.0038 UNIFORM HAZARDOUS 1.Generator ID Number _ 2.Page 1 of 3.Emeryenq Resprgr),ye Ph4n@-:� 4.Manifest Tracking Number �( WASTE MANIFEST SKS 5.Generatofs Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: -. - - 6 Tr",der 1 ComPany,Narne _ U.S.EPA ID Number _ 7.Transporter 2 Company Name U.S-EPA ID Number r - 8.Designated Facility Name and Site Address U.S.EPA ID Number Facility's Phone: ge 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 14.Total 12,Unft 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity WLNd. K Z 2. w cv 3. 4. M.Special Handling Instructions and Additional Information - 1 _ 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by the propershipping name,;dare classified,packaged, marked and Iabeledlplacarded,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,t certify that the contents of this consignment conform to the terns 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)(if I am a small quantity generator)is We. Genees/OffevesPrintedfrypedNa Signatu Month Day Year 315 j 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: M Transporter signature(for exports only): Date leaving U.S.: X 1T.Transporter Acknowledgment ofReceipt ofMaterials Transporter 1 rintedRyped Name t Signature Month Day Year a ��w+L 'S S 12- 4 4 Transporter Printedltyped Name Signatu Month Day Year nr � 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type L1Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Altemale Facility(or Generator) Month Day Year 6 z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 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 r1 3123 ?X EPA Form 8700-22Rev.12-17 Previous edifions are obsolete. DESI TED FACILITY TO EPA's e-MANIFEST SYSTEM .7� 12-17)Previous